Susan Jones Npi Number Texas

Introduction

If you are searching for Susan Jones NPI number Texas, you are likely trying to verify the credentials of a healthcare professional, submit a claim, or conduct background research. The National Provider Identifier (NPI) is a unique 10‑digit identification number assigned to every healthcare provider in the United States. Knowing how to locate the correct NPI for a Texas‑based Susan Jones can save time, ensure claim accuracy, and protect you from fraud. This article walks you through everything you need to know—from the basics of NPI numbers to a step‑by‑step method for finding the exact identifier, real‑world examples, and answers to the most common questions.

Detailed Explanation

What is an NPI number?

The National Provider Identifier (NPI) is a mandatory identifier introduced under the Health Insurance Portability and Accountability Act (HIPAA) in 1996. Every physician, nurse practitioner, therapist, clinic, and other licensed healthcare entity must have an NPI that is used across all electronic health transactions. The NPI replaces the older Provider Identification Number (PIN) and serves as a universal key for billing, electronic health records, and insurance verification.

Why the Texas context matters

Texas has over 1 million licensed medical professionals, and the state’s healthcare system is one of the largest in the nation. Because NPI numbers are not tied to state licensure boards, you cannot assume that a Texas‑based provider shares the same NPI as a similarly named provider in another state. Therefore, when you search for Susan Jones NPI number Texas, you must filter results specifically to Texas to avoid confusion with providers of the same name in other jurisdictions.

Core components of an NPI

An NPI consists of ten numeric characters (no letters or hyphens). It is divided into three functional parts:

1. Entity type – indicates whether the provider is an individual, organization, or other legal entity.
2. Provider identifier – the unique sequence assigned by the National Plan and Provider Enumeration System (NPPES).
3. Check digit – the final digit validates the number mathematically.

Understanding these components helps you verify that the number you locate is legitimate and correctly formatted.

Step‑by‑Step or Concept Breakdown

Below is a practical, step‑by‑step guide to locate the Susan Jones NPI number Texas. Follow each stage to ensure you retrieve accurate data.

1. Access the official NPI Registry

   • Go to the National Plan and Provider Enumeration System (NPPES) Registry at https://npiregistry.cms.hhs.gov/. This is the only government‑maintained database for NPI numbers.

2. Enter search criteria

   • In the search bar, type “Susan Jones” and select “Texas” from the state dropdown.
   • You can also narrow the results by entering a city (e.g., Dallas, Houston) or a specialty (e.g., “Family Medicine”).

3. Review the result list

   • The system will display a table of matching providers. Look for columns such as NPI Number, Provider Name, Address, Phone, and Specialty.
   • Verify that the Entity Type matches the professional you expect (e.g., “Individual”).

4. Validate the NPI

   • Click the “View Details” link for the specific entry.
   • Check the Number of Positions (should be 10 digits) and the Check Digit to ensure there are no typographical errors.

5. Copy the NPI for future use

   • Once confirmed, copy the 10‑digit identifier. You can paste it into claim forms, electronic health records, or verification tools.

6. Document the source

   • Keep a screenshot or export the record for audit purposes. This is especially important for compliance audits or legal documentation.

Quick‑Reference Checklist

• ✅ Search on the official NPPES site – avoid third‑party aggregators that may host outdated data.
• ✅ Filter by Texas – ensures you are looking at the correct state jurisdiction.
• ✅ Verify the 10‑digit format – any deviation suggests a mistake.
• ✅ Confirm specialty and address – matches the provider you need.

Real Examples

Example 1: Family Practitioner in Austin

A clinic in Austin, Texas, lists a Susan Jones, MD, as a family medicine physician. By entering “Susan Jones” and selecting “Texas – Austin” in the NPPES search, the registry returns the following:

• NPI: 1234567890
• Entity Type: Individual
• Address: 1234 Oak Street, Austin, TX 78701
• Specialty: Family Medicine

The clinic uses this NPI on all insurance claims, and patients can verify it on their billing statements.

Example 2: Nurse Practitioner in Houston

A telehealth platform in Houston features a Susan Jones, NP. The NPI lookup yields:

• NPI: 0987654321
• Entity Type: Individual
• Address: 5678 Pine Avenue, Houston, TX 77002
• Specialty: Psychiatric-Mental Health Nurse Practitioner

Because telehealth providers often share similar names, filtering by Specialty and City prevents confusion with another “Susan Jones” who works in pediatric care in Dallas.

Example 3: Multi‑Specialty Group Practice

A large multi‑specialty group in Dallas lists several providers named Susan Jones, each with a distinct NPI:

• Susan Jones, MD – Cardiology – NPI 1122334455
• Susan Jones, DO – Dermatology – NPI 2233445566

The group’s electronic health record (EHR) system pulls the correct NPI automatically based on the provider’s login credentials, illustrating the importance of accurate NPI data for workflow automation.

Scientific or Theoretical Perspective

The NPI system operates on a deterministic algorithm designed to guarantee uniqueness and integrity across the national healthcare ecosystem. Each NPI is generated using a check digit calculation (similar to

to a checksum) that ensures any typographical error or data entry mistake will result in an invalid NPI. This robust system minimizes the risk of misidentification and billing errors, contributing significantly to the efficiency and accuracy of healthcare transactions. The algorithm’s reliance on a mathematical formula, rather than a simple sequential number, provides a level of security and reliability crucial for managing vast amounts of patient data. Furthermore, the NPI’s structure – incorporating information about the provider’s specialty, location, and entity type – allows for granular searching and verification, reducing ambiguity and facilitating seamless data exchange between healthcare organizations.

The ongoing evolution of the NPI system reflects a commitment to adapting to the changing landscape of healthcare. Future developments are likely to incorporate enhanced data security measures and potentially integrate with broader interoperability standards, further streamlining the process of provider identification and ensuring the continued integrity of patient information.

Conclusion:

The National Provider Identifier (NPI) has become an indispensable component of the modern healthcare system. Its consistent application and diligent verification are paramount to accurate billing, efficient data management, and ultimately, improved patient care. By utilizing the resources and checklists outlined above, healthcare providers and organizations can confidently navigate the NPI landscape, minimizing errors and maximizing the benefits of this vital tool. Maintaining a proactive approach to NPI verification – including regular audits and updates – is not merely a compliance requirement, but a fundamental practice for safeguarding the integrity of healthcare operations and protecting the interests of both providers and patients.

the Luhn algorithm) to ensure data integrity. This mathematical approach guarantees that each NPI is unique and verifiable, minimizing the risk of errors in healthcare transactions. The system's deterministic nature means that given the same input data, the same NPI will always be generated, ensuring consistency across all healthcare databases.

The NPI's design also incorporates principles of data normalization, reducing redundancy and improving data quality. By assigning a single, unique identifier to each healthcare provider, the system eliminates the need for multiple identifiers across different payers and systems. This standardization facilitates seamless data exchange and interoperability, which are critical for coordinated care and population health management. The NPI's role in enabling electronic transactions aligns with broader trends in healthcare IT, supporting initiatives like meaningful use and the transition to value-based care models.

From a theoretical perspective, the NPI system exemplifies the application of information theory and systems thinking in healthcare. By creating a standardized, unique identifier, the NPI reduces information entropy and enhances the clarity of provider data across the healthcare ecosystem. This structured approach to data management supports more accurate analytics, better decision-making, and ultimately, improved patient outcomes. As healthcare continues to evolve, the NPI system's foundational principles of uniqueness, integrity, and interoperability will remain essential for managing the complex web of relationships and transactions in modern healthcare delivery.