Lakeway Medical Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKEWAY MEDICAL CLINIC, LLC

Practice address

1008 Ranch Road 620 S
Lakeway, TX 78734-5631

Phone

(512) 714-9602

NPI assigned

Dec 7, 2021

Last updated

Dec 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alex Cobarrubias

Title

Manager

Phone

(713) 551-3455

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 13

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.

• Rachel S Fowler, APRN

  • Family Nurse Practitioner
  • Georgetown, TX
  • NPI 1780396705
  Medicare reassignment Care Compare group NPD
• Derek Jason Reyes, NP

  • Family Nurse Practitioner
  • Boerne, TX
  • NPI 1598411779
  Medicare reassignment Care Compare group NPD
• Jeanine Marie Tackla, APRN, MSN, A-GNP-C,

  • Gerontology Nurse Practitioner
  • Keller, TX
  • NPI 1255612537
  Medicare reassignment Care Compare group NPD
• Amanda Michelle Dunn, APRN

  • Gerontology Nurse Practitioner
  • Plano, TX
  • NPI 1710798160
  Medicare reassignment NPD
• Mark Jordan Weisberg, M.D.

  • Internal Medicine Physician
  • Brownsville, TX
  • NPI 1568690279

  Multi-Specialty

  Medicare reassignment NPD
• Sheena Katrina Crow, NP

  • Adult Health Nurse Practitioner
  • Dallas, TX
  • NPI 1134584089
  Medicare reassignment
• Christine Roseann Idemudia, APRN-CNP

  • Family Nurse Practitioner
  • Keller, TX
  • NPI 1366192973
  NPD (past)
• Maria R Jones

  • Physician Assistant
  • Cedar Park, TX
  • NPI 1912203480
  NPD (past)
• Melissa Ortiz, APRN, FNP-C

  • Family Nurse Practitioner
  • San Antonio, TX
  • NPI 1346092335
  NPD (past)
• Alex Amilcar Quinonez, NREMT

  • Basic Emergency Medical Technician
  • Plano, TX
  • NPI 1689364077
  NPD (past)
• Christal Domonique Rockholt, FNP

  • Family Nurse Practitioner
  • Plano, TX
  • NPI 1134972961
  NPD (past)
• Candace Thrash, M.D.

  • Dermatology Physician
  • Austin, TX
  • NPI 1093764664
  NPD (past)

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1265190235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 RANCH ROAD 620 S",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345631",
            "telephone_number": "512-714-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 RANCH ROAD 620 S",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345631",
            "telephone_number": "512-714-9602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWAY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "COBARRUBIAS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "713-551-3455"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeway Era Acquistion Partners LLC (VIK Complete Care Lakeway)
• Lakeway Eye Center PC
• Lakeway Eye Physicians and Surgeons
• Lakeway Health & Wellness Chiropractic, LLC
• Lakeway Hospitalists PLLC
• Lakeway Optical LLC
• Lakeway Sports Physical Therapy
• Lakeway Vision Associates P.a.
• Tyneshia D Lamptey, D.C.
• Shannon Suzanne Lampton, CNA

• Family Medicine Physician in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.