NPIMap

Organization Active NPI

Austin Diagnostic Clinic, PA

  • Hematology & Oncology Physician
  • Austin, TX
National Provider Identifier
1487632618
Registry record updated Nov 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
AUSTIN DIAGNOSTIC CLINIC, PA
Practice address
12221 N Mo Pac Expy
Dept of Hematology/Oncology
Austin, TX 78758-2483
Phone
(512) 901-4008
Fax
(512) 901-3908
NPI assigned
Jan 6, 2006
Last updated
Nov 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2010

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

Authorized official

Name
Ellen M Andrew
Title
Credentialing Specialist
Phone
(512) 901-4937

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X NU Primary
Physician Assistant 363A00000X NU

Addresses

Primary practice location

12221 N Mo Pac Expy
Dept of Hematology/Oncology
Austin, TX 78758-2483

Mailing address

12221 N Mo Pac Expy
Dept of Hematology/Oncology
Austin, TX 78758-2483
Phone (512) 901-4008

Other identifiers 1

IdentifierTypeStateIssuer
140347921MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000236 TX Part B Supplier - Clinic/Group Practice 1254244551 Receives reassigned benefits from 132 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory
Tax ID family
The Austin Diagnostic Clinic Association20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

2005 N Lakeline Blvd
Bldg B
Cedar Park, TX 78613
Phone (512) 518-4690

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289779200000",
    "number": "1487632618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 N MO PAC EXPY",
            "address_2": "DEPT OF HEMATOLOGY/ONCOLOGY",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582483",
            "telephone_number": "512-901-4008",
            "fax_number": "512-901-3908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 N MO PAC EXPY",
            "address_2": "DEPT OF HEMATOLOGY/ONCOLOGY",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582483",
            "telephone_number": "512-901-4008",
            "fax_number": "512-901-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUSTIN DIAGNOSTIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2010-11-15",
        "status": "A",
        "authorized_official_last_name": "ANDREW",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "512-901-4937"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140347921",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; 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.