Phoenix Oncology Lost Pines PLLC

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

G3515 Issued in TX

Legal business name

PHOENIX ONCOLOGY LOST PINES PLLC

Practice address

3107 Highway 71 E
Bastrop, TX 78602-5158

Phone

(512) 303-5100

Fax

(512) 303-5106

NPI assigned

Aug 30, 2013

Organization subpart

No

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

Authorized official

Name

Jimmy Michael Kerley, MD

Title

Owner

Phone

(512) 303-5100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1377820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377820800000",
    "number": "1558795161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3107 HIGHWAY 71 E",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786025158",
            "telephone_number": "512-303-5100",
            "fax_number": "512-303-5106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3107 HIGHWAY 71 E",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786025158",
            "telephone_number": "512-303-5100",
            "fax_number": "512-303-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX ONCOLOGY LOST PINES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-30",
        "last_updated": "2013-08-30",
        "status": "A",
        "authorized_official_last_name": "KERLEY",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-303-5100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "TX",
            "license": "G3515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.