NPIMap

Organization Active NPI

Lubbock Kidney & Blood Pressure Clinic P a

  • Nephrology Physician
  • Lubbock, TX
National Provider Identifier
1316958663
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
LUBBOCK KIDNEY & BLOOD PRESSURE CLINIC P A
Practice address
1126 Slide Rd
Suite 4B
Lubbock, TX 79416-5402
Phone
(806) 793-8447
Fax
(806) 793-0498
NPI assigned
Aug 11, 2006
Last updated
May 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Authorized official

Name
Dr. Clarence J Wheeler III, M.D.NPI 1699776732
Title
M.D. President
Phone
(806) 793-8447

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

1126 Slide Rd
Suite 4B
Lubbock, TX 79416-5402

Mailing address

1126 Slide Rd
Suite 4B
Lubbock, TX 79416-5402
Phone (806) 793-8447

Other identifiers 4

IdentifierTypeStateIssuer
G-8915MedicaidNM
00DG98OtherTXBLUECROSS BLUESHIELD
C12381OtherTXPALAMETTO RAILROAD MEDICA
082186001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041207000549 TX Part B Supplier - Clinic/Group Practice 1951367481 Receives reassigned benefits from 6 practitioners
Practice locations: Lubbock, TX
O20070509000307 NM Part B Supplier - Clinic/Group Practice 1951367481 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Hobbs, NM

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1316958663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 SLIDE RD",
            "address_2": "SUITE 4B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794165402",
            "telephone_number": "806-793-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 SLIDE RD",
            "address_2": "SUITE 4B",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794165402",
            "telephone_number": "806-793-8447",
            "fax_number": "806-793-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBBOCK KIDNEY & BLOOD PRESSURE CLINIC P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "M.D. PRESIDENT",
        "authorized_official_telephone_number": "806-793-8447",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G-8915",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "00DG98",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALAMETTO RAILROAD MEDICA",
            "identifier": "C12381",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082186001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.