NPIMap

Organization Active NPI

Cedar Creek Clinic, LLC

  • Primary Care Clinic/Center
  • Gun Barrel City, TX
National Provider Identifier
1134539000
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
636969 Issued in TX
Legal business name
CEDAR CREEK CLINIC, LLC
Practice address
2418 W Main St
Gun Barrel City, TX 75156-3638
Phone
(903) 713-2000
Fax
(903) 713-2004
NPI assigned
May 1, 2014
Last updated
Feb 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Authorized official

Name
Chelsea Rae Springer
Title
Office Manager
Phone
(903) 713-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 636969 TX Primary

Addresses

Primary practice location

2418 W Main St
Gun Barrel City, TX 75156-3638

Mailing address

2418 W Main St
Gun Barrel City, TX 75156-3638
Phone (903) 713-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140811001859 TX Part B Supplier - Clinic/Group Practice 4880811108 Receives reassigned benefits from 9 practitioners
Practice locations: Gun Barrel City, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2161302Cedar Creek Clinic2418 W Main Street, Gun Barrel City, TX 75156Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory

Locations

2418 W Main St
Gun Barrel City, TX 75156
Phone (903) 713-2000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GAGGCD

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1134539000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 W MAIN ST",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751563638",
            "telephone_number": "903-713-2000",
            "fax_number": "903-713-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 W MAIN ST",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751563638",
            "telephone_number": "903-713-2000",
            "fax_number": "903-713-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-01",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "SPRINGER",
        "authorized_official_first_name": "CHELSEA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-713-2000"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "636969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gun Barrel City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.