Organization Active NPI

Epic Healthcare and Physical Medicine

  • General Practice Physician
  • Flower Mound, TX
National Provider Identifier
1518205483
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
K0566 Issued in TX
Legal business name
EPIC HEALTHCARE AND PHYSICAL MEDICINE
Practice address
1681 Justin Rd
Suite 100
Flower Mound, TX 75028-4323
Phone
(972) 420-0083
NPI assigned
Jan 28, 2013
Last updated
Jan 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Dr. Carlos Venegas, M.D.NPI 1558385252
Title
Owner
Phone
(214) 542-0321

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
General Practice Physician 208D00000X K0566 TX Primary

Addresses

Primary practice location

1681 Justin Rd
Suite 100
Flower Mound, TX 75028-4323

Mailing address

1681 Justin Rd
Suite 100
Flower Mound, TX 75028-4323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130426000060 TX Part B Supplier - Clinic/Group Practice 5890931422 Receives reassigned benefits from 9 practitioners
Practice locations: Flower Mound, TX
O20131108001391 TX DME Supplier - Physician - Internal Medicine 5890931422 Practice locations: Flower Mound, TX

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2179268Epic Healthcare & Physical Medicine, PA1681 Justin Rd Suite 100, Flower Mound, TX 75028Certificate of waiverFeb 18, 2028

National Provider Directory

National Provider Directory

Locations

1681 Justin Rd
Ste 100
Flower Mound, TX 75028
Phone (972) 355-0083

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1518205483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1681 JUSTIN RD",
            "address_2": "SUITE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750284323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1681 JUSTIN RD",
            "address_2": "SUITE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750284323",
            "telephone_number": "972-420-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIC HEALTHCARE AND PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "VENEGAS",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-542-0321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "K0566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.