Individual provider Active NPI

Jose Guadalupe Garcia, MPAS, PA-C

  • Physician Assistant
  • Odessa, TX
National Provider Identifier
1366794463
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA08173 Issued in TX
Practice address
4060 Medical Park Dr
Odessa, TX 79765-2233
Phone
(432) 582-2882
Fax
(432) 582-2884
NPI assigned
Oct 12, 2012
Last updated
Jun 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA08173 TX Primary

Addresses

Primary practice location

4060 Medical Park Dr
Odessa, TX 79765-2233

Mailing address

4060 Medical Park Dr
Odessa, TX 79765-2233
Phone (432) 582-2882

Other identifiers 1

IdentifierTypeStateIssuer
373243001MedicaidTX

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140107000427 TX Practitioner - Physician Assistant 0648408211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dora Roberts Rehabilitation CenterGroup PAC ID 0941285498, 114 clinicians
Francisco J. Salcido, M.D. P.a.Group PAC ID 7618152281, 8 clinicians

Practice addresses (Care Compare)

306 W 3Rd St
Big Spring, TX 79720-2429
Phone (432) 267-3806

4060 Medical Park Dr
Odessa, TX 79765-2233
Phone 43258222822

460 Medical Park Dr
Odessa, TX 79765-2233

710 E 6TH St
Odessa, TX 79761-4655
Phone (432) 582-2882

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1366794463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 MEDICAL PARK DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797652233",
            "telephone_number": "432-582-2882",
            "fax_number": "432-582-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 MEDICAL PARK DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797652233",
            "telephone_number": "432-582-2882",
            "fax_number": "432-582-2884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "JOSE",
        "middle_name": "GUADALUPE",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-12",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "373243001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.