NPIMap

Organization Active NPI

Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
National Provider Identifier
1083630610
Registry record updated Apr 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
CONCORD MEDICAL GROUP PLLC
Practice address
1602 Avenue Q
Lubbock, TX 79401-4732
Phone
(888) 264-0330
Fax
(800) 611-5029
NPI assigned
Jul 15, 2006
Last updated
Apr 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2026

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

Authorized official

Name
Mrs. Jordan Ann Tuckett
Title
Evp of Operations
Phone
(972) 829-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

1602 Avenue Q
Lubbock, TX 79401-4732

Mailing address

PO Box 3689
Department 257
Sugar Land, TX 77487-3310
Phone (888) 264-0330

Other identifiers 1

IdentifierTypeStateIssuer
200065501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK, LA, TN, AR5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20050707000531 TX Part B Supplier - Clinic/Group Practice 0446296818 Receives reassigned benefits from 1,362 practitioners
1 other NPI on this enrollment
Practice locations: Hereford, TX; Jacksboro, TX; Kenedy, TX; Kermit, TX; Kingsville, TX; Lamesa, TX; Littlefield, TX; Llano, TX…
O20140523001063 OK Part B Supplier - Clinic/Group Practice 0446296818 Receives reassigned benefits from 35 practitioners
Practice locations: Perry, OK; Shattuck, OK
O20140930001176 LA Part B Supplier - Clinic/Group Practice 0446296818 Receives reassigned benefits from 219 practitioners
Practice locations: Deridder, LA; Jonesboro, LA; Springhill, LA
O20151006000818 TN Part B Supplier - Clinic/Group Practice 0446296818 Receives reassigned benefits from 118 practitioners
Practice locations: Camden, TN; Waverly, TN; Parsons, TN; Erin, TN; Copperhill, TN; Manchester, TN
O20190325001423 AR Part B Supplier - Clinic/Group Practice 0446296818 Receives reassigned benefits from 58 practitioners
Practice locations: El Dorado, AR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5001 E Main St
Erin, TN 37061
Phone (336) 944-6420

1500 S Sunset Ave
Littlefield, TX 79339
Phone (806) 385-6411

4750 President George Bush Tpke
Sachse, TX 75048
Phone (214) 477-7647

Practitioners & affiliated clinicians

Practitioners 1,781

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.

View all 1,781

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777507200000",
    "number": "1083630610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3689",
            "address_2": "DEPARTMENT 257",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774873310",
            "telephone_number": "888-264-0330",
            "fax_number": "800-611-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 AVENUE Q",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794014732",
            "telephone_number": "888-264-0330",
            "fax_number": "800-611-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORD MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A",
        "authorized_official_last_name": "TUCKETT",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EVP OF OPERATIONS",
        "authorized_official_telephone_number": "972-829-6610",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200065501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; 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.