Individual provider Active NPI

Lashandra Mae Gilmore, NP

  • Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1285336966
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1084164 Issued in TX
Practice address
19284 Stone Oak Pkwy Ste 102
San Antonio, TX 78258-3474
Phone
(210) 268-0120
Fax
(210) 268-0170
NPI assigned
Mar 20, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1084164 TX Primary
General Practice Registered Nurse 163WG0000X 1084164 TX

Addresses

Primary practice location

19284 Stone Oak Pkwy Ste 102
San Antonio, TX 78258-3474

Mailing address

4438 Centerview
San Antonio, TX 78228-1440
Phone (210) 748-7366

Other practice location 1

4438 Centerview
San Antonio, TX 78228-1440
Phone (210) 748-7366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231228001298 TX Practitioner - Nurse Practitioner 7113374034 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1084164TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Institute of Gastroenterology Associates , PA CurrentSince Oct 15, 2023 Accepting new patients
Joycelyn M. Theard M.D,P.a. PastSince Oct 15, 2023 Accepting new patients

Locations

580 Cibolo Valley Dr
Ste 249
Cibolo, TX 78108
Phone (210) 268-0120

19284 Stone Oak Pkwy
Ste 104
San Antonio, TX 78258
Phone (210) 268-0120

19284 Stone Oak Pkwy
Ste 102
San Antonio, TX 78258
Phone (210) 268-0124

Interoperability endpoints

  • Direct secure messaging: lashandra.gilmore.1@29421.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1285336966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 CENTERVIEW",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281440",
            "telephone_number": "210-748-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19284 STONE OAK PKWY STE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583474",
            "telephone_number": "210-268-0120",
            "fax_number": "210-268-0170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4438 Centerview",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782281440",
            "country_code": "US",
            "telephone_number": "210-748-7366",
            "fax_number": "302-288-5520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "LASHANDRA",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1084164",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "TX",
            "license": "1084164",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.