NPIMap

Organization Active NPI

Permian Cardiology, Inc.

  • Cardiovascular Disease Physician
  • Midland, TX
National Provider Identifier
1275836736
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PERMIAN CARDIOLOGY, INC.
Practice address
400 Rosalind Redfern Grover Pkwy
Suite 240
Midland, TX 79701-5846
Phone
(432) 683-2723
Fax
(432) 683-4907
NPI assigned
Dec 6, 2010
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Candace Wynne
Title
Credentialing
Phone
(432) 686-6605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X TX Primary

Addresses

Primary practice location

400 Rosalind Redfern Grover Pkwy
Suite 240
Midland, TX 79701-5846

Mailing address

400 Rosalind Redfern Grover Pkwy
Suite 240
Midland, TX 79701-5846
Phone (432) 683-2723

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CANDACE.WYNNE@MIDLANDHEALTH.ORG Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110120000590 TX Part B Supplier - Clinic/Group Practice 2163601303 Receives reassigned benefits from 9 practitioners
Practice locations: Midland, TX

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0508693Permian Cardiology Inc400 Rosalind Redfern Grover Parkway Ste 240, Midland, TX 79701Certificate of waiverJul 31, 2026

National Provider Directory

National Provider Directory

Locations

400 N Garfield
#240
Midland, TX 79701
Phone (432) 683-2723

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1275836736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 ROSALIND REDFERN GROVER PKWY",
            "address_2": "SUITE 240",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015846",
            "telephone_number": "432-683-2723",
            "fax_number": "432-683-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROSALIND REDFERN GROVER PKWY",
            "address_2": "SUITE 240",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015846",
            "telephone_number": "432-683-2723",
            "fax_number": "432-683-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERMIAN CARDIOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-06",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "WYNNE",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "432-686-6605"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CANDACE.WYNNE@MIDLANDHEALTH.ORG",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "400 Rosalind Redfern Grover Pkwy",
            "address_2": "Suite 240",
            "city": "Midland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "797015846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.