Timu Niratsuwan Kwi, MD
Individual provider Active NPI Family Medicine Physician · Port Lavaca, TX
NPI 1164465415 · NPPES record last updated Dec 22, 2009
Key facts
- NPI
- 1164465415
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- L6546 (TX)
- Practice address
- 1200 N Virginia St
Port Lavaca, TX 77979-2507 - Phone
- (361) 552-6721
- Fax
- (361) 552-7463
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 7
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Loma Linda University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Port Lavaca Clinic Associates PA
Practice addresses (Care Compare)
1200 N Virginia St
Port Lavaca, TX 77979-2507
Phone (361) 553-6567
Hospital & facility affiliations
- Calhoun Home Health, L.L.C.
- Texas Home Health Skilled Services
- Hospice of South Texas Inc
- Memorial Medical Center
- De Tar Hospital Navarro
- Citizens Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Port Lavaca Clinic Associates PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (25%) Corporate Officer (25%) |
Dec 4, 2017 Dec 4, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050125000555 | TX | Practitioner - Family Practice | 8628028941 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Port Lavaca Clinic Associates PA | Family Medicine | Current |
Accepting new patients |
| Memorial Medical Center | Past | Accepting new patients | |
| Citizens Medical Center County of Victoria | Past | Accepting new patients |
Locations
1200 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-6721
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L6546 | TX | Yes |
Addresses
Primary practice location
1200 N Virginia St
Port Lavaca, TX 77979-2507
Mailing address
1200 N Virginia St
Port Lavaca, TX 77979-2507
Phone (361) 552-6721
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000H160 | Other | TX | GROUP MEDICARE NUMBER |
| 133513502 | Other | TX | GROUP MEDICAID NUMBER |
| 160771501 | Medicaid | TX |
Other providers in Port Lavaca, TX
- Kestler Chiropractic Clinic,LLC
- Bryan Claude Kestler
- Shaukat Ali Khan
- Chrisandra L Kovarek
- Gillian V. Kwi
- Nhi P Le
- Phuong Le
- Mau Shong Lin
- Adamiley Luna
- Mabel Allene Hunt
All providers in Port Lavaca, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.