NPIMap

Organization Active NPI

Clarendon Family Medicine PLLC

  • Clinic/Center
  • Clarendon, TX
National Provider Identifier
1497458319
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CLARENDON FAMILY MEDICINE PLLC
Practice address
One Medical Center Drive
Clarendon, TX 79226
Phone
(806) 874-3531
NPI assigned
Mar 22, 2023
Last updated
May 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Dustin PrattNPI 1912199456
Title
MD
Phone
(940) 585-8482

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

One Medical Center Drive
Clarendon, TX 79226

Mailing address

15986 FM 2042
Childress, TX 79201

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230614001029 TX Part B Supplier - Clinic/Group Practice 0749648376 Receives reassigned benefits from 6 practitioners
Practice locations: Clarendon, TX

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

1 Medical Dr
Clarendon, TX 79226
Phone (806) 874-2244

Practitioners & affiliated clinicians

Practitioners 7

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": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1497458319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15986 FM 2042",
            "city": "CHILDRESS",
            "state": "TX",
            "postal_code": "79201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DRIVE",
            "city": "CLARENDON",
            "state": "TX",
            "postal_code": "79226",
            "telephone_number": "806-874-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARENDON FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-05-09",
        "certification_date": "2023-04-29",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "940-585-8482"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarendon, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.