Covenant Medical Group

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

COVENANT MEDICAL GROUP

Doing business as

Covenant Family Healthcare Center

Practice address

409 8TH St
Abernathy, TX 79311-3416

Phone

(806) 298-5884

Fax

(806) 298-5889

NPI assigned

Oct 23, 2012

Last updated

Sep 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristen Kothmann

Title

Coo/VP

Phone

(806) 725-7800

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Covenant Family Healthcare Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538412895. Details of each certification follow.

• CCN 673910 Rural health clinic · Active · Details

Rural health clinic certification: CCN 673910

Legal name

COVENANT MEDICAL GROUP

Doing business as

COVENANT FAMILY HEALTHCARE CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 16, 2009

Last certification

Jan 26, 2016

Ownership / control type

2B

Most recent change of ownership

Aug 1, 2012 (1 total)

Organization structure

OtherNon-profit

Enrollment address

409 8TH St
Abernathy, TX 79311-3416

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  6901889393

  Same PAC ID

Tax ID family

Basha Diagnostics3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Covenant Medical Group

  dba Covenant Medical Group Urgent Care

  • Urgent Care Clinic/Center
  • Lubbock, TX
  • NPI 1417381187
  NPD tax ID
• Basha Diagnostics P C

  • Diagnostic Radiology Physician
  • Royal Oak, MI
  • NPI 1770693798
  NPD tax ID

Locations (25 of 48)

All disclosed owners & managing parties 1

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

Practitioners 417

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.

• Cynthia Adame, FNP

  • Family Nurse Practitioner
  • Lubbock, TX
  • NPI 1730624099
  NPD
• Achankeng Afiadata, M.D.

  • Urology Physician
  • Lubbock, TX
  • NPI 1851786321
  NPD
• Oluwafemi Akinnawo, MD

  • Pediatrics Physician
  • Fort Bliss, TX
  • NPI 1780207654
  NPD
• Khondoker Alam, M.D

  • Neurology Physician
  • Lubbock, TX
  • NPI 1992185201
  NPD
• Clarissa N Aldape, MD

  • Hospitalist Physician
  • Houston, TX
  • NPI 1447638630
  NPD
• Mohammed Hussein Nasser Aljarwi, MD

  • Pediatrics Physician
  • Midland, TX
  • NPI 1013320050
  NPD
• Mohamad Jamil Alkul, MD

  • Pediatrics Physician
  • Lubbock, TX
  • NPI 1467415158
  NPD
• Rangasamy Krishnan Anand, MBBS, MRCP(UK)

  • Pediatric Critical Care Medicine Physician
  • Harlingen, TX
  • NPI 1558570333
  NPD
• Kyle S. Anderson, DO

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1942939079
  NPD
• Gabriel Axelrud, M.D.

  • Radiation Oncology Physician
  • Lubbock, TX
  • NPI 1376955435
  NPD
• Faidah O Badru, MD

  • Pediatric Surgery Physician
  • Lubbock, TX
  • NPI 1740613629
  NPD
• Michael Gene Bailey, MD

  • Family Medicine Physician
  • Levelland, TX
  • NPI 1487642393
  NPD

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1538412895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 8TH ST",
            "city": "ABERNATHY",
            "state": "TX",
            "postal_code": "793113416",
            "telephone_number": "806-298-5884",
            "fax_number": "806-298-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-23",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A",
        "authorized_official_last_name": "KOTHMANN",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "COO/VP",
        "authorized_official_telephone_number": "806-725-7800"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328182601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "673910",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.covhs.org/open",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2215 Nashville Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794101105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Covenant Family Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Covenant Family Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan G Byrd
• Century 100 Management (Golden Estates)
• Century 100 Management
• City of Abernathy (Abernathy VEMS)
• Maria J Cortez, FNP
• CP Healthcare, LLC (Abernathy Drug & Mercantile)
• Educare Community Living Limited Partnership
• Ashley J Elliott
• Mari Lynn Evans, L.P.C.
• Maria Teresa Flores, MSN, APRN, FNP-BC

• Rural Health Clinic/Center in Abernathy, TX
• Providers in Abernathy, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.