Lake Granbury Internal Medicine & Pediatrics, PA
NPI 1972608636 · Internal Medicine Physician · Granbury, TX
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Lake Granbury Internal Medicine & Pediatrics, PA is a Internal Medicine Physician organization in Granbury, TX (NPI 1972608636).
Provider details
- NPI number
- 1972608636
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Penelope Jackson, Physician/Owner(817) 579-1005
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Pediatrics Physician208000000X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-09-14
- Last updated
- 2014-04-02
Frequently asked questions
- What is Lake Granbury Internal Medicine & Pediatrics, PA's NPI number?
- Lake Granbury Internal Medicine & Pediatrics, PA's National Provider Identifier (NPI) is 1972608636, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lake Granbury Internal Medicine & Pediatrics, PA?
- Lake Granbury Internal Medicine & Pediatrics, PA is classified in the NPPES registry as Internal Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Lake Granbury Internal Medicine & Pediatrics, PA located?
- Lake Granbury Internal Medicine & Pediatrics, PA's practice location on file with NPPES is 2005 Rockview Drive, Granbury, TX 76049.
- What is Lake Granbury Internal Medicine & Pediatrics, PA's phone number?
- The practice phone number listed in the NPPES registry for Lake Granbury Internal Medicine & Pediatrics, PA is (817) 579-1005.
- Does Lake Granbury Internal Medicine & Pediatrics, PA accept Medicare?
- Lake Granbury Internal Medicine & Pediatrics, PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Lake Granbury Internal Medicine & Pediatrics, PA?
- The authorized official listed on Lake Granbury Internal Medicine & Pediatrics, PA's NPPES record is Penelope Jackson, Physician/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lake Granbury Internal Medicine & Pediatrics, PA's NPI active?
- Yes — Lake Granbury Internal Medicine & Pediatrics, PA's NPI (1972608636) is active in the NPPES registry as of the last update on 2014-04-02.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.