Lion Star Nacogdoches Hospital, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LION STAR NACOGDOCHES HOSPITAL, LLC

Doing business as

Nacogdoches Memorial Professional Group

Practice address

1204 N Mound St
Nacogdoches, TX 75961-4027

Phone

(936) 568-8427

NPI assigned

Sep 10, 2021

Last updated

Aug 16, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

LION STAR NACOGDOCHES HOSPITAL, LLCAs reported in NPPES

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

Authorized official

Name

Matthew Malloy, RN

Title

Director of Operations

Phone

(936) 568-8427

Specialties & licenses 15

Addresses

Other names 1

• Nacogdoches Memorial Professional Group Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Lion Star Nacogdoches Hospital LLC

Locations

Interoperability endpoints

• Direct secure messaging: nmd@scs.nacowl.net

Practitioners 14

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.

• Erin Elizabeth Bailey, NP

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1326254517
  Medicare reassignment Care Compare group NPD
• Swapna Reddy Bemalgi, M.D.,

  • Internal Medicine Physician
  • Lufkin, TX
  • NPI 1629389861
  Medicare reassignment Care Compare group NPD
• Bao Quoc Bui, M.D.

  • Internal Medicine Physician
  • Lufkin, TX
  • NPI 1841483708
  Medicare reassignment Care Compare group NPD
• Robert Busuego, MD

  • Internal Medicine Physician
  • Lufkin, TX
  • NPI 1477966596
  Medicare reassignment Care Compare group NPD
• Srinivasa Gurram, M.D

  • Internal Medicine Physician
  • Lufkin, TX
  • NPI 1417360538
  Medicare reassignment Care Compare group NPD
• Carla Ann Hairston, RN,FNP

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1124020631
  Medicare reassignment Care Compare group NPD
• Maria Jenkins

  • Family Nurse Practitioner
  • Nacogdoches, TX
  • NPI 1720445851
  Medicare reassignment Care Compare group NPD
• Munawwer Khurshid, M.D.

  • Neurology Physician
  • Nacogdoches, TX
  • NPI 1699733378

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Joshua Gaige Mason, APRN FNP-C

  • Family Nurse Practitioner
  • Livingston, TX
  • NPI 1659119352
  Medicare reassignment Care Compare group NPD
• Chikezie John Ochieze, M.D.

  • Hospitalist Physician
  • Lufkin, TX
  • NPI 1548616170

  Family Medicine

  Medicare reassignment Care Compare group NPD
• James M Otto, M.D.

  • Internal Medicine Physician
  • Nacogdoches, TX
  • NPI 1477690766
  Medicare reassignment Care Compare group NPD
• James Robert Stockman Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Nacogdoches, TX
  • NPI 1225334790
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1316616550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614027",
            "telephone_number": "936-568-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614027",
            "telephone_number": "936-568-8427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LION STAR NACOGDOCHES HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LION STAR NACOGDOCHES HOSPITAL, LLC",
        "enumeration_date": "2021-09-10",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A",
        "authorized_official_last_name": "MALLOY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "936-568-8427",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NMD@scs.nacowl.net",
            "affiliation": "Y",
            "affiliationName": "Lion Star Nacogdoches Hospital, LLC",
            "address_1": "1204 N Mound St",
            "city": "Nacogdoches",
            "state": "TX",
            "country_code": "US",
            "postal_code": "759614027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nacogdoches Memorial Professional Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nacogdoches Memorial Professional Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Nacogdoches, TX
• Providers in Nacogdoches, 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 Aug 16, 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.