Primary Care of Eagle Pass PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIMARY CARE OF EAGLE PASS PLLC

Practice address

1975 N Veterans Blvd Ste 9
Eagle Pass, TX 78852-4456

Phone

(830) 213-8186

Fax

(830) 213-8157

NPI assigned

May 15, 2023

Organization subpart

No

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

Authorized official

Name

David W Chisum, MDNPI 1417586991

Title

Sole Member

Phone

(830) 213-8186

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• David Westly Chisum, MD

  • Family Medicine Physician
  • Eagle Pass, TX
  • NPI 1417586991

  Family Medicine, TX

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1043901788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 N VETERANS BLVD STE 9",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788524456",
            "telephone_number": "830-213-8186",
            "fax_number": "830-213-8157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 N VETERANS BLVD STE 9",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788524456",
            "telephone_number": "830-213-8186",
            "fax_number": "830-213-8157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF EAGLE PASS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "CHISUM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "830-213-8186",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Performance Therapeutics - Eagle Pass PLLC
• Performance Therapeutics - Eagle Pass, PLLC
• Cynthia Picazo
• Thomas Anthony Pitts III
• Jacob Pizana
• Priscilla R Heredia OD PLLC
• Patricia Macatangay Quinio
• Eduardo Jose Quintanilla Jerez, MD
• R R Hixson, Inc.
• Cassandra Michelle Ramirez

• All providers in Eagle Pass, TX
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.