Individual provider Active NPI

Mariana Elizabeth Moncrief

  • Physician Assistant
  • Lubbock, TX
National Provider Identifier
1487341350
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17240 Issued in TX
Practice address
13803 Avenue S
Lubbock, TX 79423-2435
Phone
(281) 853-4807
NPI assigned
Apr 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 1212140 TX
Surgical Physician Assistant 363AS0400X PA17240 TX
Physician Assistant 363A00000X PA17240 TX Primary

Addresses

Primary practice location

13803 Avenue S
Lubbock, TX 79423-2435

Mailing address

3601 4TH St Stop 7260
Lubbock, TX 79430-2435
Phone (806) 743-1810

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
I20231108004090 TX Practitioner - Physician Assistant 2264889427 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11011 Slide Rd
Lubbock, TX 79424-2274
Phone (806) 743-2584

3601 4TH St
Lubbock, TX 79430-0002

3601 4TH St
Lubbock, TX 79430-8312
Phone (806) 743-2373

602 Indiana Ave
Lubbock, TX 79415-3364
Phone (806) 743-1842

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.52 of 100Reported as apm
Quality
87.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1212140TXMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Oct 2, 2023 Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Oct 2, 2023 Accepting new patients
Texas Tech University Health Sciences Center Lubbock PastSince Nov 12, 2023 Accepting new patients

Locations

11011 Slide Rd
Lubbock, TX 79424
Phone (806) 743-2584

3601 4th St
Stop 7260
Lubbock, TX 79430
Phone (806) 743-1810

3601 4th St
Lubbock, TX 79430
Phone (806) 743-1000

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 5

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": "1681948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699574400000",
    "number": "1487341350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 4TH ST STOP 7260",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794302435",
            "telephone_number": "806-743-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13803 AVENUE S",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794232435",
            "telephone_number": "281-853-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCRIEF",
        "first_name": "MARIANA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-20",
        "last_updated": "2023-11-10",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "1212140",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA17240",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA17240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.