LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
NPI 1972608636
Internal Medicine in Granbury, TX
NPI Status: Active since September 14, 2006
Contact Information
2005 ROCKVIEW DRIVE
GRANBURY, TX
ZIP 76049
Phone: (817) 579-1005
Fax: (817) 579-1093
- Organization
- Internal Medicine
- CLIA Number: 45D2307601
- CLIA Cert. Type: Other - FREESTANDING ER
- CLIA Exp. Date: 07-10-2026
About LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
This page provides the complete NPI Profile along with additional information for Lake Granbury Internal Medicine & Pediatrics, Pa, an internist established in Granbury, Texas operating as a Internal Medicine. The healthcare provider is registered in the NPI registry with number 1972608636 assigned on September 2006. The practitioner's primary taxonomy code is 207R00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. Lake Granbury Internal Medicine & Pediatrics, Pa operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Dr. Penelope A. Jackson M.d. (Physician/owner)
- NPI
- 1972608636
- Provider Name
- LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
- Entity Type
- Organization
- Location Address
- 2005 ROCKVIEW DRIVE GRANBURY, TX 76049
- Location Phone
- (817) 579-1005
- Location Fax
- (817) 579-1093
- Mailing Address
- 2005 ROCKVIEW DRIVE GRANBURY, TX 76049
- Mailing Phone
- (817) 579-1005
- Mailing Fax
- (817) 579-1093
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-14-2006
- Last Update Date
- 04-02-2014
- Code Navigator
An internist like Lake Granbury Internal Medicine & Pediatrics, Pa is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D2307601
- Facility Type
- Other - FREESTANDING ER
- Certificate Effective Date
- July 11, 2024
- Certificate Expiration Date
- July 10, 2026
- Laboratory Director
- MELISSA HARDIN
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Lake Granbury Internal Medicine & Pediatrics, Pa on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1972608636, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 64 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1972608636, enumerated as an "organization" on September 14, 2006.
The provider is located at 2005 ROCKVIEW DRIVE GRANBURY, TX 76049 and the phone number is (817) 579-1005.
Internal Medicine with taxonomy code 207R00000X.
