Pineywoods Diagnostic Clinic of East Texas PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PINEYWOODS DIAGNOSTIC CLINIC OF EAST TEXAS PA

Practice address

400 W Church St
Livingston, TX 77351-3416

Phone

(936) 327-7733

Fax

(936) 327-2248

NPI assigned

Nov 1, 2006

Last updated

Jul 31, 2008By 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

Ravinder R Bachireddy, M.D.NPI 1023094703

Title

Authorized/Delegated Official

Phone

(936) 632-8787

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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.

• Anita M Kuruvilla, M.D.

  • Internal Medicine Physician
  • Lufkin, TX
  • NPI 1851377477
  Medicare reassignment NPD
• Ravinder R Bachireddy, M.D.

  • Interventional Cardiology Physician
  • Lufkin, TX
  • NPI 1023094703

  Cardiovascular Disease

  NPD (past) Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1265519730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151226",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759151226",
            "telephone_number": "936-632-8787",
            "fax_number": "936-632-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W CHURCH ST",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773513416",
            "telephone_number": "936-327-7733",
            "fax_number": "936-327-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEYWOODS DIAGNOSTIC CLINIC OF EAST TEXAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-07-31",
        "status": "A",
        "authorized_official_last_name": "BACHIREDDY",
        "authorized_official_first_name": "RAVINDER",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "AUTHORIZED/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "936-632-8787",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS & BLUESHIELD",
            "identifier": "0022MU",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176384901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hao Mai Ngoc Pham, DDS
• Vien Thuy Pham, MD
• Amber Phelps, MED, LPC
• Christy Philip
• Le'Shauna N Pickens, APRN-CNP
• Colton Placker
• Jeffrey Warren Plunkett
• Peggy Elizabeth Plunkett
• Polk County
• Spencer Elaine Pope

• Internal Medicine Physician in Livingston, TX
• Providers in Livingston, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.