Individual provider Active NPI

Kathleen Anne Cubine, DO

  • Family Medicine Physician
  • San Angelo, TX
National Provider Identifier
1356312839
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J1959 Issued in TX
Practice address
2626 N Bryant Blvd
San Angelo, TX 76903-2861
Phone
(325) 658-1511
Fax
(325) 481-2165
NPI assigned
Jan 31, 2006
Last updated
May 15, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J1959 TX Primary

Addresses

Primary practice location

2626 N Bryant Blvd
San Angelo, TX 76903-2861

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 658-1511

Other identifiers 3

IdentifierTypeStateIssuer
8V9834OtherTXBLUE CROSS
8A8895OtherTXBCBS
130498208MedicaidTX

Other names 1

  • Miss Kathleen Anne Gatts Other name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040302001240 TX Practitioner - Family Practice 7618864828 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC CurrentSince Mar 21, 2015 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Mar 21, 2015 Accepting new patients
Regional Employee Assistance Program Inc Family Medicine Past Accepting new patients
East Texas Medical Center Healthcare Associates Past Accepting new patients
Regional Employee Assistance Program Inc Past Accepting new patients

Locations

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

5900 Altamesa Blvd
Ft Worth, TX 76132
Phone (817) 433-9100

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

400 SW 25th Ave
Mineral Wells, TX 76067
Phone (940) 325-7891

305 N McKinney St
Sweeny, TX 77480
Phone (979) 548-1500

Interoperability endpoints

  • Direct secure messaging: kcubine6452@shannonhealth.direct-ci.com

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1356312839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 N BRYANT BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769032861",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUBINE",
        "first_name": "KATHLEEN",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-31",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J1959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8V9834",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8A8895",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130498208",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "GATTS",
            "middle_name": "ANNE",
            "prefix": "MISS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.