Individual provider Active NPI

Guillermo Antonio Lopez-Gonzalez, M.D.

  • Emergency Medicine Physician
  • Odessa, TX
National Provider Identifier
1609293802
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T4204 Issued in TX
Practice address
701 W 5TH St
Odessa, TX 79763-4206
Phone
(432) 703-5245
NPI assigned
Mar 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X T4204 TX
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X T4204 TX Primary

Addresses

Primary practice location

701 W 5TH St
Odessa, TX 79763-4206

Mailing address

28112 Heritage TRL
Fair Oaks Ranch, TX 78015-6526
Phone (210) 589-2547

Other practice location 1

11100 Euclid Ave
Cleveland, OH 44106-1716
Phone (216) 844-1000

Other practice location 2

1700 E Saunders St
Laredo, TX 78041-5474
Phone (956) 796-5000 ext. 3934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221215001371 TX Practitioner - Family Practice 2769863380 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas a & M University System, HSC, College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Laredo Emergency Medicine Associates PAGroup PAC ID 5395741896, 45 clinicians

Practice addresses (Care Compare)

1700 E Saunders St
Laredo, TX 78041-5401
Phone (956) 796-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.42 of 100Reported as group
Quality
73.44
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Laredo Emergency Medicine Associates PA Emergency Medicine CurrentSince May 7, 2023 Accepting new patients
Basin Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2022 Accepting new patients

Locations

1700 E Saunders St
Laredo, TX 78041
Phone (956) 206-6971

9811 McPherson Rd
Laredo, TX 78045
Phone (956) 796-3900

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1609293802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28112 HERITAGE TRL",
            "city": "FAIR OAKS RANCH",
            "state": "TX",
            "postal_code": "780156526",
            "telephone_number": "210-589-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-703-5245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11100 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441061716",
            "country_code": "US",
            "telephone_number": "216-844-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 E Saunders St",
            "address_purpose": "LOCATION",
            "city": "Laredo",
            "state": "TX",
            "postal_code": "780415474",
            "country_code": "US",
            "telephone_number": "956-796-5000 x3934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ-GONZALEZ",
        "first_name": "GUILLERMO",
        "middle_name": "ANTONIO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2023-02-02",
        "certification_date": "2022-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T4204",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T4204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.