James B Kopp, MD
Individual provider Active NPI Family Medicine Physician · Randolph a F B, TX
NPI 1366416372 · NPPES record last updated Oct 3, 2013
Key facts
- NPI
- 1366416372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- L1913 (TX)
- Practice address
- 221 3Rd St W
BLDG 1040
Randolph a F B, TX 78150-4800 - Phone
- (210) 652-3383
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shannon Clinic
Practice addresses (Care Compare)
2626 N Bryant Blvd
San Angelo, TX 76903-2861
Phone (325) 747-1511
Hospital & facility affiliations
- Shannon Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.63 of 100
- Quality
- 78.21
- Promoting interoperability
- 96
- Improvement activities
- 40
- Cost
- 67.22
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050325000361 | TX | Practitioner - Family Practice |
4082660709 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L1913 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shannon Clinic | Family Medicine | Current |
Accepting new patients |
| Concord Radiology PLLC | Past | Accepting new patients | |
| East San Antonio Images Inc | Past | Accepting new patients |
Locations
2626 N Bryant Blvd
San Angelo, TX 76903
Phone (325) 481-2000
120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511
3502 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 747-2222
Interoperability endpoints
- jkopp6810@shannonhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L1913 | TX | Yes |
Addresses
Primary practice location
221 3Rd St W
BLDG 1040
Randolph a F B, TX 78150-4800
Mailing address
221 3Rd St W
BLDG 1040
Randolph a F B, TX 78150-4800
Phone (210) 652-3383
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 171884301 | Medicaid | TX |
Other providers in Randolph a F B, TX
- 12TH Medical Group Randolph
- Catherine Emily Biersack
- David Carey
- Cesario Ferrer Ferrer Jr.
- John I Hudson
- James Ronald Little
- John James McDonald
- Richard Leroy Mooney
- Jesse Wayne Richardson
- Phillip R. Sandefur
All providers in Randolph a F B, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.