CMS-1500 Box 24J / 33a • NPI
1073696357
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
208000000X (CMS 37)
Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)
Box 32 Service Location & ZIP+4
202 S. THIRD STREET, GANADO, TX, 77962-1214
✓ 9-Digit EDI 837 ZIP+4 (77962-1214)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1073696357 (JACKSON COUNTY HOSPITAL DISTRICT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1073696357 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | JACKSON COUNTY HOSPITAL DISTRICT |
| Plain-English Specialty | Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) NUCC Code: 208000000X (Pediatrics) |
| Certifying / Licensing Body | American Board of Pediatrics (ABP) |
| Practice Location Address | 202 S. THIRD STREET, GANADO, TX, 77962-1214 |
| Practice Telephone / Fax | Tel: (361) 771-3571 | Fax: (361) 771-3574 |
| Administrative Mailing Address | 1013 S WELLS ST, EDNA, TX, 77957-4098 |
| Enumeration & Last Sync | Enumerated: 2006-10-23 | CMS Record Updated: 2025-09-11 |
| Authorized Official | MARCELLA HENKE (Administrator/CEO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in GANADO
🔒 Are you JACKSON COUNTY HOSPITAL DISTRICT? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (208000000X)
What Does Taxonomy Code 208000000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208000000X translates to:
"Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (JACKSON COUNTY HOSPITAL DISTRICT)
Typical CPT / Diagnostic Procedures:- Comprehensive Well-Child Developmental & Growth Visits (CPT 99381–99394)
- Childhood Immunization Administration (Rotavirus, MMR, DTaP, HPV, PCV)
- Neonatal Bilirubin & Jaundice Transcutaneous/Serum Screening
- Rapid Streptococcal, RSV & Influenza Point-of-Care Diagnostics
- Pediatric Asthma Nebulization & Spirometry Evaluation
- Amoxicillin / Amoxicillin-Clavulanate (Pediatric Otitis Media & Sinusitis)
- WHO Low-Osmolarity Oral Rehydration Salts (ORS) & Zinc Sulfate
- Albuterol Sulfate Inhalers & Fluticasone Pediatric Inhalers
- Weight-Based Acetaminophen & Ibuprofen Antipyretic Suspensions
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207R00000X — Internal MedicinePlain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician) | State: N/A | License: Verified | Primary: Secondary |
208D00000X — General PracticePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice | State: N/A | License: Verified | Primary: Secondary |
208000000X — PediatricsPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.