NPIMap

Organization Active NPI

Texas Tech University Health Sciences Center El Paso

  • Family Medicine Physician
  • El Paso, TX
National Provider Identifier
1124072681
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO
Practice address
9849 Kenworthy St
El Paso, TX 79924-4402
Phone
(915) 757-2581
Fax
(915) 751-4378
NPI assigned
May 20, 2006
Last updated
Apr 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

Name
Sue Fuciarelli
Title
Vice President for Finance and Admi
Phone
(915) 215-4300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

9849 Kenworthy St
El Paso, TX 79924-4402

Mailing address

PO Box 9520
El Paso, TX 79995-9520
Phone (915) 545-6664

Other practice location 1

2000 B Transmountain Road
El Paso, TX 79911
Phone (915) 215-8408

Other identifiers 1

IdentifierTypeStateIssuer
084597601MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000806 TX Part B Supplier - Clinic/Group Practice 7517864754 Receives reassigned benefits from 864 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: El Paso, TX; Alpine, TX

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1124072681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9520",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799959520",
            "telephone_number": "915-545-6664",
            "fax_number": "915-545-9799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9849 KENWORTHY ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799244402",
            "telephone_number": "915-757-2581",
            "fax_number": "915-751-4378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 B Transmountain Road",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "79911",
            "country_code": "US",
            "telephone_number": "915-215-8408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "FUCIARELLI",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR FINANCE AND ADMI",
        "authorized_official_telephone_number": "915-215-4300"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084597601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.