Organization Active NPI

Mario a Lammoglia MD PA

  • Cardiovascular Disease Physician
  • College Station, TX
National Provider Identifier
1053598755
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
K1859 Issued in TX
Legal business name
MARIO A LAMMOGLIA MD PA
Practice address
1721 Birmingham Dr
College Station, TX 77845-4082
Phone
(979) 764-1474
Fax
(979) 764-9249
NPI assigned
Jan 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Montana Oliver
Title
Patient Account Manager
Phone
(979) 764-1474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X K1859 TX Primary

Addresses

Primary practice location

1721 Birmingham Dr
College Station, TX 77845-4082

Mailing address

1721 Birmingham Rd
College Station, TX 77845-4082
Phone (979) 764-1474

Other identifiers 1

IdentifierTypeStateIssuer
199331301MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080927000173 TX Part B Supplier - Clinic/Group Practice 2567539877 Receives reassigned benefits from 1 practitioner
Practice locations: College Station, TX

National Provider Directory

National Provider Directory

Locations

1721 Birmingham Rd
College Station, TX 77845
Phone (979) 695-9540

Practitioners & affiliated clinicians

Practitioners 1

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": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1053598755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 BIRMINGHAM RD",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778454082",
            "telephone_number": "979-764-1474",
            "fax_number": "979-764-9249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 BIRMINGHAM DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778454082",
            "telephone_number": "979-764-1474",
            "fax_number": "979-764-9249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO A LAMMOGLIA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-24",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "MONTANA",
        "authorized_official_title_or_position": "PATIENT ACCOUNT MANAGER",
        "authorized_official_telephone_number": "979-764-1474"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "K1859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199331301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.