CHILDREN'S CLINIC OF JASPER — NPI 1093168049 (Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) in JASPER, TX)

CMS-1500 Box 24J / 33a • NPI

1093168049

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

1008 DICKERSON DR, JASPER, TX, 75951-5111

✓ 9-Digit EDI 837 ZIP+4 (75951-5111)

Practice Phone & Referral Fax

(936) 634-2214

Fax: (936) 639-9660

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093168049 (CHILDREN'S CLINIC OF JASPER) 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

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093168049` (NPI-2 Organization / Facility)
Provider / Legal Name	CHILDREN'S CLINIC OF JASPER
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	1008 DICKERSON DR, JASPER, TX, 75951-5111
Practice Telephone / Fax	Tel: (936) 634-2214 \| Fax: (936) 639-9660
Administrative Mailing Address	PO BOX 150638, LUFKIN, TX, 75915-0638
Enumeration & Last Sync	Enumerated: 2016-07-14 \| CMS Record Updated: 2016-07-14
Authorized Official	CHERE CROCKER (Office Manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1008 DICKERSON DR, JASPER, TX, 75951-5111

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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)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 37 (Physician/Pediatric Medicine)
Certifying / Accrediting Authority: American Board of Pediatrics (ABP)
Clinical Scope: Newborn jaundice screening, routine childhood vaccinations, developmental milestones, pediatric fevers, ear infections, asthma, or acute gastroenteritis.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CHILDREN'S CLINIC OF JASPER)

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

Common Therapeutic Classes:

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
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: TX \| License: `H4321` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CHILDREN'S CLINIC OF JASPER (NPI #1093168049)