Active NPI
Eddie Lee Summers Jr., DDS
- General Practice Dentistry
- Texas City, TX
National Provider Identifier
1104005123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15457
- Practice address
- 9850 Emmett F Lowry Expy Ste C
Suite C-103
Texas City, TX 77591-2001 - Phone
- (409) 949-3406
- Fax
- (409) 949-3492
- NPI assigned
- Oct 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 15457 | TX | Primary |
Addresses
Primary practice location
9850 Emmett F Lowry Expy Ste C
Suite C-103
Texas City, TX 77591-2001
Mailing address
314 S Golden Oak Dr
Texas City, TX 77591-9275
Phone (409) 935-5663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15457 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Health & Wellness | Past | Accepting new patients | |
| Coastal Health & Wellness | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
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 and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Texas City, TX
- NPI 1578588406
-
- Federally Qualified Health Center (FQHC)
- Texas City, TX
- NPI 1619667565
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350259200000",
"number": "1104005123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 S GOLDEN OAK DR",
"city": "TEXAS CITY",
"state": "TX",
"postal_code": "775919275",
"telephone_number": "409-935-5663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9850 EMMETT F LOWRY EXPY STE C",
"address_2": "SUITE C-103",
"city": "TEXAS CITY",
"state": "TX",
"postal_code": "775912001",
"telephone_number": "409-949-3406",
"fax_number": "409-949-3492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERS",
"first_name": "EDDIE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-25",
"last_updated": "2012-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "15457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texas City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.