Organization Active NPI

West Texas Urology PA

  • Specialist
  • Midland, TX
National Provider Identifier
1467453860
Registry record updated Feb 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
H3422 Issued in TX
Legal business name
WEST TEXAS UROLOGY PA
Practice address
2706 W Cuthbert BLDG C
Midland, TX 79701-3887
Phone
(432) 687-0311
Fax
(432) 687-0312
NPI assigned
Aug 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2014

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

Authorized official

Name
Dr. John Barry Staub, MD
Title
President
Phone
(432) 687-0311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X H3422 TX Primary

Addresses

Primary practice location

2706 W Cuthbert BLDG C
Midland, TX 79701-3887

Mailing address

2706 W Cuthbert BLDG C
Midland, TX 79701-3887
Phone (432) 687-0311

Other identifiers 2

IdentifierTypeStateIssuer
172553301MedicaidTX
45D0508718OtherTXCLIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050330000658 TX Part B Supplier - Clinic/Group Practice 1557317781 Receives reassigned benefits from 9 practitioners
Practice locations: Odessa, TX; Midland, TX

National Provider Directory

National Provider Directory

Locations

540 W 5th St
Ste 420
Odessa, TX 79761
Phone (432) 582-2280

420 E 6th St
Ste 101
Odessa, TX 79761
Phone (432) 614-6376

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392768000000",
    "number": "1467453860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2706 W CUTHBERT BLDG C",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797013887",
            "telephone_number": "432-687-0311",
            "fax_number": "432-687-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2706 W CUTHBERT BLDG C",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797013887",
            "telephone_number": "432-687-0311",
            "fax_number": "432-687-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST TEXAS UROLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2014-02-19",
        "status": "A",
        "authorized_official_last_name": "STAUB",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "432-687-0311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "H3422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172553301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D0508718",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; 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.