MRS. NICOLE BLACKWELL JENNINGS (PA-C) – Gastroenterology Physician, NPI 1730290990
Gastroenterology Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MRS. NICOLE BLACKWELL JENNINGS (PA-C)
1308 PALUXY RD STE 300
GRANBURY, TX 760485689
Phone: (817) 579-3978
Fax: (817) 579-3977
Type: Mailing
PO BOX 733784
DALLAS, TX 753733784
Phone: (682) 885-6163
Fax: (682) 885-1396
Type: Mailing
1500 COOPER ST
FORT WORTH, TX 761042710
Phone: (682) 885-2500
Fax: (682) 885-2510
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $100.
Total Amount is formed as General ($100) + Research ($0) + Ownership ($0) = $100.
Last reported payment date: 2024-11-15 • Largest payer in this snapshot: Medtronic, Inc. ($85).
Total Amount
$100
General + Research + Ownership
Payments
4
Total payment records
General Amount
$100
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-15
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $85 |
| ClearPoint Neuro, Inc. | $16 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-01-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100107000538 | I | Physician Assistant | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76048)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease, Internal Medicine | TX | |
| Nurse Practitioner | TX | |
| Family Practice | TX | |
| - | TX | |
| Nurse Practitioner | TX | |
| U R O L O G Y | TX | |
| Family Practice | TX | |
| General Surgery | TX | |
| Osteopathic Manipulative Medicine | WV | |
| Nurse Practitioner | TX |
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