Active NPI
Sixtus Atabong, PA
- Surgical Physician Assistant
- Lubbock, TX
National Provider Identifier
1013987155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA04629
- Practice address
- 4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520 - Phone
- (806) 744-7223
- Fax
- (806) 740-3325
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA04629 | TX | Primary |
Addresses
Primary practice location
4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520
Mailing address
4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520
Phone (806) 744-7223
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8Y0194 | Other | TX | BCBS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | satabong1379970@oc.providencedirect.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051021000194 | TX | Practitioner - Physician Assistant | 9234155979 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Grace Clinic of Lubbock
Practice addresses (Care Compare)
4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520
Phone (806) 744-7223
7509 Marsha Sharp Fwy
Lubbock, TX 79407-8202
Phone (806) 725-4000
Hospital & facility affiliations
- Grace Surgical Hospital
- Covenant Hospital Plainview
- Artesia General Hospital
- Nor-Lea Hospital District
- W J Mangold Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Clinic of Lubbock | Current | Accepting new patients |
Locations
4515 Marsha Sharp Fwy
Lubbock, TX 79407
Phone 80674472232432
Interoperability endpoints
- satabong@yourcarecommunity.org
- satabong1379970@oc.providencedirect.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Lubbock, TX
- NPI 1770237042
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Plainview, TX
- NPI 1073580726
Hospital
-
- Ambulatory Surgical Clinic/Center
- Plainview, TX
- NPI 1174630198
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643846400000",
"number": "1013987155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4515 MARSHA SHARP FWY",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794072520",
"telephone_number": "806-744-7223",
"fax_number": "806-740-3325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 MARSHA SHARP FWY",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794072520",
"telephone_number": "806-744-7223",
"fax_number": "806-740-3325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ATABONG",
"first_name": "SIXTUS",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2022-02-03",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "PA04629",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8Y0194",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "satabong1379970@oc.providencedirect.org",
"affiliation": "N",
"address_1": "4515 Marsha Sharp Fwy",
"city": "Lubbock",
"state": "TX",
"country_code": "US",
"postal_code": "794072520",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.