NPIMap

Organization Active NPI

Texas Retina Associates

  • Ophthalmology Physician
  • Lubbock, TX
National Provider Identifier
1093750853
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TEXAS RETINA ASSOCIATES
Practice address
4517 98TH St
Lubbock, TX 79424-5013
Phone
(806) 792-0066
NPI assigned
Jun 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Authorized official

Name
Jefferey T. Brockette
Title
Ceo
Phone
(214) 692-6941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

4517 98TH St
Lubbock, TX 79424-5013

Mailing address

PO Box 650037
Dallas, TX 75265-0037
Phone (214) 696-2008

Other identifiers 2

IdentifierTypeStateIssuer
094850703MedicaidTX
G4476MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050221000018 TX Part B Supplier - Clinic/Group Practice 7012969843 Receives reassigned benefits from 18 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dallas, TX; Woodway, TX; Wichita Falls, TX; Sherman, TX; Rockwall, TX; Plano, TX; Mansfield, TX; Lubbock, TX…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Texas Retina Associates6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6767 Southwest Pkwy
Ste 160
Wichita Falls, TX 76310
Phone (940) 691-3232

Practitioners & affiliated clinicians

Practitioners 5

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": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1093750853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 650037",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752650037",
            "telephone_number": "214-696-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 98TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794245013",
            "telephone_number": "806-792-0066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS RETINA ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "BROCKETTE",
        "authorized_official_first_name": "JEFFEREY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-692-6941"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094850703",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G4476",
            "state": "NM"
        }
    ],
    "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 Dec 1, 2011; 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.