William Nisimblat Mdpa

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WILLIAM NISIMBLAT MDPA

Practice address

305 E Third St
Alice, TX 78332-4705

Phone

(361) 664-5291

Fax

(361) 668-1630

NPI assigned

Oct 2, 2006

Organization subpart

No

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

Authorized official

Name

William Nisimblat, MD

Title

Owner

Phone

(361) 664-5291

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Alice Pediatric Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Rural health clinic certification: CCN 453956

Legal name

WILLIAM NISIMBLAT MDPA

Doing business as

ALICE PEDIATRIC CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 14, 1994

Last certification

Jul 1, 2015

Ownership / control type

1A

Organization structure

OtherProprietary

Incorporated

Jul 12, 1989 in TX

Enrollment address

305 E 3Rd St
Alice, TX 78332-4705

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Erik Nisimblat, MD

  • Pediatrics Physician
  • Alice, TX
  • NPI 1083707012

  5% Or Greater Direct Ownership Interest, Corporate Officer

  CMS ownership

Practitioners 5

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

• Maria Annabel Perez, NP

  • Family Nurse Practitioner
  • Alice, TX
  • NPI 1851057947
  NPD
• Clarissa Tijerina, FNP

  • Family Nurse Practitioner
  • Alice, TX
  • NPI 1720828627

  Single Specialty

  NPD
• Tara Mendietta, FNPC

  • Family Nurse Practitioner
  • Alice, TX
  • NPI 1467929083
  NPD (past)
• Erik Nisimblat, MD

  • Pediatrics Physician
  • Alice, TX
  • NPI 1083707012

  Pediatrics

  NPD (past)
• Franz I Puyol, MD

  • Pediatrics Physician
  • Allas, TX
  • NPI 1639262678

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1477646271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 289",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783334705",
            "telephone_number": "361-664-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E THIRD ST",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783324705",
            "telephone_number": "361-664-5291",
            "fax_number": "361-668-1630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM NISIMBLAT MDPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "NISIMBLAT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-664-5291",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119654501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119654502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alice Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walter a. del Gallo, M.D.,P.a.
• West Wharton County Hospital District
• Erin White, OTR
• Kendell R White, FNP-C
• Dean Delbert Wieben, D.C.
• Women'S and Men'S Health Services of the Coastal Bend, Inc.
• Brittany Woodard, ATC, LAT
• Paige Anne Woodring, D.D.S
• Cesar E Yevenes, LPT
• Emily Yuasa

• All providers in Alice, TX
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.