NPIMap

Organization Active NPI

Lubbock Diagnostic Radiology, L.L.P.

  • Diagnostic Radiology Physician
  • Lubbock, TX
National Provider Identifier
1215028501
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
LUBBOCK DIAGNOSTIC RADIOLOGY, L.L.P.
Practice address
4005 24TH St
Lubbock, TX 79410-1835
Phone
(806) 792-2767
Fax
(888) 861-8858
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Authorized official

Name
Mr. Monty Medanich
Title
C.O.O.
Phone
(806) 792-2767

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X

Addresses

Primary practice location

4005 24TH St
Lubbock, TX 79410-1835

Mailing address

PO Box 1620
Lubbock, TX 79408-1620
Phone (806) 792-2767

Other identifiers 4

IdentifierTypeStateIssuer
CG7043OtherRAILROAD MEDICARE
62866OtherNEW MEXICO MEDICAID
0094EEOtherTXBLUE CROSS
095055202MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031219000036 TX Part B Supplier - Clinic/Group Practice 4183521859 Receives reassigned benefits from 19 practitioners
Practice locations: Levelland, TX; Lubbock, TX

National Provider Directory

National Provider Directory

Locations

3716 21st St
Lubbock, TX 79410
Phone (806) 725-8700

4005 24th St
Lubbock, TX 79410
Phone (806) 795-2767

3716 21st St
Ste 206
Lubbock, TX 79410
Phone (806) 793-3746

2303 Quaker Ave
Lubbock, TX 79410
Phone (806) 725-8700

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1215028501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1620",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794081620",
            "telephone_number": "806-792-2767",
            "fax_number": "806-791-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 24TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101835",
            "telephone_number": "806-792-2767",
            "fax_number": "888-861-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBBOCK DIAGNOSTIC RADIOLOGY, L.L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "MEDANICH",
        "authorized_official_first_name": "MONTY",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "806-792-2767",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG7043",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO MEDICAID",
            "identifier": "62866",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0094EE",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "095055202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.