NPIMap

Organization Active NPI

Neurological Surgery Specialist of North Texas PLLC

  • Neurological Surgery Physician
  • Wichita Falls, TX
National Provider Identifier
1003389636
Registry record updated Aug 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NEUROLOGICAL SURGERY SPECIALIST OF NORTH TEXAS PLLC
Practice address
3808 Kemp Blvd Ste a
Wichita Falls, TX 76308-2150
Phone
(940) 234-3000
Fax
(940) 234-3005
NPI assigned
Jan 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Kern Jr., MD
Title
Owner -Sole Member
Phone
(940) 723-4572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

3808 Kemp Blvd Ste a
Wichita Falls, TX 76308-2150

Mailing address

3808 Kemp Blvd Ste a
Wichita Falls, TX 76308-2150
Phone (940) 234-3000

Other identifiers 2

IdentifierTypeStateIssuer
377596701MedicaidTX
3775967-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190318000091 TX Part B Supplier - Clinic/Group Practice 3072853910 Receives reassigned benefits from 9 practitioners
Practice locations: Chillicothe, TX; Graham, TX; Wichita Falls, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567123200000",
    "number": "1003389636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 KEMP BLVD STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763082150",
            "telephone_number": "940-234-3000",
            "fax_number": "940-234-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 KEMP BLVD STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763082150",
            "telephone_number": "940-234-3000",
            "fax_number": "940-234-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGICAL SURGERY SPECIALIST OF NORTH TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-08-30",
        "status": "A",
        "authorized_official_last_name": "KERN JR.",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER -SOLE MEMBER",
        "authorized_official_telephone_number": "940-723-4572",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377596701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3775967-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.