NPIMap

Individual provider Active NPI

Shandi Christine Moralez, FNP-BC

  • Primary Care Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1083364764
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
764096 Issued in TX
Practice address
4010 22ND St
Lubbock, TX 79410-1116
Phone
(806) 767-1727
NPI assigned
Mar 25, 2022
Last updated
Aug 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Nurse Practitioner 363LC1500X 1073705 TX
Family Nurse Practitioner 363LF0000X 764096 TX
Primary Care Nurse Practitioner 363LP2300X 764096 TX Primary

Addresses

Primary practice location

4010 22ND St
Lubbock, TX 79410-1116

Mailing address

3610 41St St
Lubbock, TX 79413-3018
Phone (806) 777-0027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220426002489 TX Practitioner - Nurse Practitioner 2365839180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lubbock Regional MHMR CenterGroup PAC ID 6800782376, 23 clinicians

Practice addresses (Care Compare)

1950 Aspen Ave
Lubbock, TX 79404-1211
Phone (806) 740-1400

4010 22ND St
Lubbock, TX 79410-1116
Phone (806) 766-0310

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1073705TXMDCommunity Health Nurse Practitioner
764096TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lubbock Regional MHMR Center Primary Care CurrentSince Apr 1, 2022 Accepting new patients
Covenant Health System PastSince Aug 14, 2022 Accepting new patients

Locations

1950 Aspen Ave
Lubbock, TX 79404
Phone (806) 740-1400

4010 22nd St
Lubbock, TX 79410
Phone (806) 725-5627

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1083364764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 41ST ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794133018",
            "telephone_number": "806-777-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 22ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101116",
            "telephone_number": "806-767-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORALEZ",
        "first_name": "SHANDI",
        "middle_name": "CHRISTINE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "TX",
            "license": "1073705",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "764096",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "764096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.