Individual provider Active NPI

Robert A Woodard II, D.C.

  • Chiropractor
  • Lake Jackson, TX
National Provider Identifier
1134539570
Registry record updated May 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12614 Issued in TX
Practice address
209 Parking Way St
Suite B
Lake Jackson, TX 77566-5226
Phone
(979) 292-8032
NPI assigned
May 7, 2014
Last updated
May 30, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 12614 TX Primary

Addresses

Primary practice location

209 Parking Way St
Suite B
Lake Jackson, TX 77566-5226

Mailing address

209 Parking Way St
Suite B
Lake Jackson, TX 77566-5226
Phone (979) 292-8032

Other identifiers 1

IdentifierTypeStateIssuer
362694ZZXPOtherTXMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140912000438 TX Practitioner - Chiropractic 5395964050 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

209 Parking Way St
Suite B
Lake Jackson, TX 77566-5226
Phone (979) 292-8032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12614TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Deetle Beetle Corp. Chiropractor CurrentSince Jan 4, 2016 Accepting new patients
Lake Jackson Chiropractic and Rehab PC Chiropractor CurrentSince Apr 11, 2017 Accepting new patients
Flux Metabolic Restoration Center PLLC PastSince Jul 25, 2011 Accepting new patients

Locations

209 Parking Way St
Ste B
Lake Jackson, TX 77566
Phone (979) 292-8032

6922 W Rayford Rd
Ste 400
Spring, TX 77389
Phone (281) 786-4922

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496102400000",
    "number": "1134539570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 PARKING WAY ST",
            "address_2": "SUITE B",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665226",
            "telephone_number": "979-292-8032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 PARKING WAY ST",
            "address_2": "SUITE B",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665226",
            "telephone_number": "979-292-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODARD",
        "first_name": "ROBERT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-07",
        "last_updated": "2017-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "12614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "362694ZZXP",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; 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.