NPIMap

Organization Active NPI

Lubbock Gastroenterology & Liver Associates PLLC

  • Gastroenterology Physician
  • Lubbock, TX
National Provider Identifier
1356979397
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LUBBOCK GASTROENTEROLOGY & LIVER ASSOCIATES PLLC
Practice address
4505 82ND St Ste 5
Lubbock, TX 79424-3219
Phone
(806) 696-4440
Fax
(806) 696-4441
NPI assigned
Mar 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Authorized official

Name
Rafiul Islam, MDNPI 1043473820
Title
Owner
Phone
(806) 696-4440

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
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

4505 82ND St Ste 5
Lubbock, TX 79424-3219

Mailing address

4505 82ND St Ste 5
Lubbock, TX 79424-3219
Phone (806) 696-4440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200415001281 TX Part B Supplier - Clinic/Group Practice 0941630966 Receives reassigned benefits from 16 practitioners
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory

Locations

4505 82nd St
Lubbock, TX 79424

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1356979397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 82ND ST STE 5",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243219",
            "telephone_number": "806-696-4440",
            "fax_number": "806-696-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 82ND ST STE 5",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243219",
            "telephone_number": "806-696-4440",
            "fax_number": "806-696-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBBOCK GASTROENTEROLOGY & LIVER ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-27",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "ISLAM",
        "authorized_official_first_name": "RAFIUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-696-4440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 12, 2021; 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.