NPIMap

Organization Active NPI

Segue Health of Texas PLLC

  • Family Medicine Physician
  • Azle, TX
National Provider Identifier
1215510763
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SEGUE HEALTH OF TEXAS PLLC
Practice address
6815 Hill CT
Azle, TX 76020-5513
Phone
(901) 626-3515
Fax
(844) 364-2629
NPI assigned
May 3, 2021
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Camille Clark
Title
Executive Director
Phone
(901) 626-3515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

6815 Hill CT
Azle, TX 76020-5513

Mailing address

765 Woodland Trace LN
Cordova, TN 38018-6609
Phone (901) 626-3515

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL cclark@seguehealth.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210713001669 TX Part B Supplier - Clinic/Group Practice 8921400953 Receives reassigned benefits from 36 practitioners
Practice locations: Azle, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1215510763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 WOODLAND TRACE LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186609",
            "telephone_number": "901-626-3515",
            "fax_number": "844-364-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6815 HILL CT",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760205513",
            "telephone_number": "901-626-3515",
            "fax_number": "844-364-2629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEGUE HEALTH OF TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "901-626-3515"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "cclark@seguehealth.net",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6815 Hill Ct",
            "city": "Azle",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760205513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Azle, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.