The Austin Diagnostic Clinic, PLLC
Organization Active NPI Internal Medicine Physician · Austin, TX
NPI 1073591202 · NPPES record last updated Nov 20, 2025
Key facts
- NPI
- 1073591202
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- THE AUSTIN DIAGNOSTIC CLINIC, PLLC
- Practice address
- 12221 N Mo Pac Expy
Dept of Internal Medicine
Austin, TX 78758 - Phone
- (512) 901-4009
- Fax
- (512) 901-3909
- NPI assigned
- Jan 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Nicholas Wadlington
- Title
- Group Vice President
- Phone
- (804) 446-9440
Other NPIs on the same Medicare enrollment 24
Corporate family (same tax ID) 19
Practitioners 5
-
Lisa Wun Kam Gaw, MD
-
Mumnoon Haider, M.D.
-
Neelu Kohli, RD LD
-
Mahmoud N Soubra, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031112000236 | TX | Part B Supplier - Clinic/Group Practice | 1254244551 |
Receives reassigned benefits from 132 practitioners 24 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- The Austin Diagnositc C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
12221 N Mo Pac Expy
Dept of Internal Medicine
Austin, TX 78758
Mailing address
2000 Health Park Dr
Brentwood, TN 37027-4692
Phone (615) 373-7406
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140347921 | Medicaid | TX |
NPI Registry JSON
{
"created_epoch": "1136505600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1763596800000",
"number": "1073591202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 HEALTH PARK DR",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370274692",
"telephone_number": "615-373-7406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12221 N MO PAC EXPY",
"address_2": "DEPT OF INTERNAL MEDICINE",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78758",
"telephone_number": "512-901-4009",
"fax_number": "512-901-3909"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE AUSTIN DIAGNOSTIC CLINIC, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-06",
"last_updated": "2025-11-20",
"certification_date": "2025-11-20",
"status": "A",
"authorized_official_last_name": "WADLINGTON",
"authorized_official_first_name": "NICHOLAS",
"authorized_official_title_or_position": "GROUP VICE PRESIDENT",
"authorized_official_telephone_number": "804-446-9440"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "140347921",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
- The Austin Dentist, PLLC
- The Austin Diagnostic Clinic Association
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
- The Austin Diagnostic Clinic, PLLC
All providers in Austin, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.