NPIMap

Individual provider Active NPI

William Eric Pack, DPM

  • Foot & Ankle Surgery Podiatrist
  • Conroe, TX
National Provider Identifier
1083702922
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
1243 Issued in TX
Practice address
690 S Loop 336 West
Suite 150
Conroe, TX 77304-3319
Phone
(936) 760-1200
Fax
(936) 760-1210
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 1243 TX Primary

Addresses

Primary practice location

690 S Loop 336 West
Suite 150
Conroe, TX 77304-3319

Mailing address

690 S Loop 336 West
Suite 150
Conroe, TX 77304-3319
Phone (936) 760-1200

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
I20101228000195 TX Practitioner - Podiatry 4183812647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 1993
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

690 S Loop 336
Suite 150
Conroe, TX 77304-3321
Phone (936) 760-1200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.07 of 100Reported as individual
Quality
77.4
Promoting interoperability
95
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue72
Removal of nail tissue33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1243TXMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Foot Surgeons, PLLC Single Specialty CurrentSince Apr 1, 2012 Accepting new patients

Locations

690 S Loop 336 W
Ste 150
Conroe, TX 77304
Phone (936) 760-1200

4015 I 45 N
Ste 210
Conroe, TX 77304
Phone (713) 667-4600

Interoperability endpoints

  • Direct secure messaging: william.pack.1@4049.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/4049/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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 9

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1083702922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 WEST",
            "address_2": "SUITE 150",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043319",
            "telephone_number": "936-760-1200",
            "fax_number": "936-760-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 WEST",
            "address_2": "SUITE 150",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043319",
            "telephone_number": "936-760-1200",
            "fax_number": "936-760-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "WILLIAM",
        "middle_name": "ERIC",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "1243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.