NPIMap

Organization Active NPI

Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
National Provider Identifier
1376598904
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COVENANT MEDICAL GROUP
Practice address
2215 Nashville Ave
Lubbock, TX 79410-1105
Phone
(806) 725-4800
Fax
(806) 723-6532
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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

Authorized official

Name
Kristen Kothmann
Title
Coo
Phone
(806) 725-4800

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207K00000X
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X

Addresses

Primary practice location

2215 Nashville Ave
Lubbock, TX 79410-1105

Mailing address

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

Other identifiers 5

IdentifierTypeStateIssuer
A7086MedicaidNM
NM007E61OtherNMBCBS NM
0038GHOtherTXBCBS TX
141656201MedicaidTX
G1594MedicaidNM

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://fhir.covhs.org/open Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040608000563 TX Part B Supplier - Clinic/Group Practice 6901889393 Receives reassigned benefits from 301 practitioners
O20041110000465 NM Part B Supplier - Clinic/Group Practice 6901889393 Receives reassigned benefits from 27 practitioners
1 other NPI on this enrollment
Practice locations: Hobbs, NM; Roswell, NM; Clovis, NM

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations (25 of 80)

7 Industrial Way
Ste 5
Salem, NH 03079

612 N 13th St
Ste J
Artesia, NM 88210
Phone (505) 746-3119

2000 W 21st St
Ste W8
Clovis, NM 88101
Phone (505) 763-4479

2000 W 21st St
Ste W1
Clovis, NM 88101
Phone (505) 763-4057

5320 N Lovington Hwy
Ste 101
Hobbs, NM 88240

911 W Avenue D
Lovington, NM 88260

7 Care Cir
Amarillo, TX 79124
Phone (806) 353-9191

6406 N Interstate 35
Ste 2600
Austin, TX 78752
Phone (512) 465-4800

1608 W FM 700
Ste E
Big Spring, TX 79720
Phone (915) 267-1441

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

5001 Statesman Dr
Irving, TX 75063
Phone (469) 524-1506

1510 N Bryan Ave
Lamesa, TX 79331
Phone (806) 872-7494

116 John Dupree Dr
Ste D
Levelland, TX 79336
Phone (806) 794-2465

3601 21st St
Lubbock, TX 79410
Phone (806) 791-0399

3610 21st St
Ste 109
Lubbock, TX 79410

3606 21st St
Ste 105
Lubbock, TX 79410

3802 21st St
Lubbock, TX 79410

4007 34th St
Lubbock, TX 79410

9812 Slide Rd
Ste 2400
Lubbock, TX 79424

3601 4th St
Stop 8143
Lubbock, TX 79430
Phone (806) 743-2757

3615 19th St
Ste 119
Lubbock, TX 79410

3506 21st St
Ste 607
Lubbock, TX 79410
Phone (806) 370-6186

3606 21st St
Ste 207
Lubbock, TX 79410
Phone (806) 725-1500

2102 Oxford Ave
Ste B
Lubbock, TX 79410
Phone (806) 725-6466

3514 21st St
#L
Lubbock, TX 79410

Practitioners & affiliated clinicians

Practitioners 578

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

View all 578

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1376598904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-4800",
            "fax_number": "806-723-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "KOTHMANN",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "806-725-4800"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A7086",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NM",
            "identifier": "NM007E61",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TX",
            "identifier": "0038GH",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141656201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G1594",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.covhs.org/open",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2215 Nashville Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794101105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Sep 23, 2020; 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.