Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jason Buckaloo, PA

Individual provider Physician Assistant · NPI 1164016663

Jason Buckaloo, PA is a Physician Assistant in Tyler, Texas. Qualified in 2023, 3 years ago. Practices with Etmc Physician Group, Inc, a 376-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
3
Licensed in
TX
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

700 Olympic Plaza Cir Ste 600
Tyler, TX 75701-1954
Phone: (903) 596-3844
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA19895 (TX)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA19895 (TX)

Record details

NPI number1164016663
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedFebruary 24, 2021
Last updated in NPPESJune 16, 2026
Certification dateJune 16, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Etmc Physician Group, Inc. — 376 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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