NPIMap

Individual provider Active NPI

David A Flack, M. D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Wichita Falls, TX
National Provider Identifier
1376545335
Registry record updated Feb 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
G5046 Issued in TX
Practice address
1209 Brook Ave
Wichita Falls, TX 76301-5601
Phone
(940) 322-7284
Fax
(940) 322-8938
NPI assigned
Jun 2, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X G5046 TX Primary

Addresses

Primary practice location

1209 Brook Ave
Wichita Falls, TX 76301-5601

Mailing address

1107 Brook Ave
Wichita Falls, TX 76301-5008
Phone (940) 322-8800

Other identifiers 2

IdentifierTypeStateIssuer
PO80P2466MedicaidTX
80P246OtherTXBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100916000679 TX Practitioner - Pathology 4981634136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Medical School at San Antonio, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Associates of North Texas, P aGroup PAC ID 7719960608, 6 clinicians

Practice addresses (Care Compare)

1209 Brook Ave
Wichita Falls, TX 76301-5601
Phone (940) 322-7284

Hospital & facility affiliations

  • United Regional Health Care System Hospital, Wichita Falls, TX, CCN 450010

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G5046TXMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Regional Health Care System Inc Current Accepting new patients
Pathology Associates of North Texas, P a Anatomic Pathology & Clinical Pathology CurrentSince Aug 10, 1988 Accepting new patients
Pathology Associates of North Texas, P a Current Accepting new patients
North Central Texas Community Health Care Center, Inc PastSince Jan 1, 2020 Accepting new patients

Locations

1209 Brook Ave
Wichita Falls, TX 76301
Phone (940) 322-7284

1107 Brook Ave
Wichita Falls, TX 76301
Phone (940) 322-0202

Interoperability endpoints

  • Direct secure messaging: dflack13741@unitedregional.medalliesdirect.net
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Healthcare CenterWichita Falls, TX, CCN 451894 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Community Healthcare Center-Juarez Medical ClinicWichita Falls, TX, CCN 671943 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Pediatric AssociatesWichita Falls, TX, CCN 741987 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Women'S Health Center of McKinneyMcKinney, TX, CCN 451061 Federally qualified health center Corporate Director (4%) Jan 1, 2020
North Central Texas Community Health Care Center IncWichita Falls, TX, CCN 451102 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Community Healthcare Center at Vernon College Wichita FallsWichita Falls, TX, CCN 451114 Federally qualified health center Corporate Director (4%) Jan 1, 2020
North Central Texas Community Health Care Center IncWichita Falls, TX, CCN 451131 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Family Health Center on VirginiaMcKinney, TX, CCN 451128 Federally qualified health center Corporate Director (4%) Jan 1, 2020
North Central Texas Community Health Care Center IncVernon, TX, CCN 451143 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Phyllis Hiraki Dental ClinicWichita Falls, TX, CCN 451193 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Women'S Health Center of PlanoPlano, TX, CCN 671054 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Club Health Center of VernonVernon, TX, CCN 671078 Federally qualified health center Corporate Director (4%) Jan 1, 2020
Pediatric Associates 10TH StreetWichita Falls, TX, CCN 671092 Federally qualified health center Corporate Director (4%) Jan 1, 2020
CHC at Wilbarger GeneralVernon, TX, CCN 971043 Federally qualified health center Corporate Director (4%) Jan 1, 2020

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203638400000",
    "number": "1376545335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015008",
            "telephone_number": "940-322-8800",
            "fax_number": "940-322-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 BROOK AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763015601",
            "telephone_number": "940-322-7284",
            "fax_number": "940-322-8938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-02",
        "last_updated": "2008-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "G5046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PO80P2466",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "80P246",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.