NPIMap

Organization Active NPI

MCH Traumacare

  • Surgery Physician
  • Odessa, TX
National Provider Identifier
1043956915
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MCH TRAUMACARE
Practice address
540 W 5TH St Ste 330
Odessa, TX 79761-5065
Phone
(432) 640-3445
NPI assigned
May 12, 2022
Last updated
Sep 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Authorized official

Name
Garret Davis
Title
Secretary
Phone
(432) 640-2414

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

540 W 5TH St Ste 330
Odessa, TX 79761-5065

Mailing address

540 W 5TH St Ste 330
Odessa, TX 79761-5065
Phone (432) 640-3445

Other practice location 1

500 W 4th St
Odessa, TX 79761-5001
Phone (432) 640-4000 ext. 3445

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220804001173 TX Part B Supplier - Clinic/Group Practice 4486036662 Receives reassigned benefits from 6 practitioners
Practice locations: Odessa, TX

National Provider Directory

National Provider Directory

Locations

540 W 5th St
Ste 330
Odessa, TX 79761
Phone (432) 580-5400

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1043956915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 W 5TH ST STE 330",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615065",
            "telephone_number": "432-640-3445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 W 5TH ST STE 330",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615065",
            "telephone_number": "432-640-3445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "TX",
            "postal_code": "797615001",
            "country_code": "US",
            "telephone_number": "432-640-4000 x3445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MCH TRAUMACARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-12",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GARRET",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "432-640-2414"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.