Individual provider Active NPI

Lauren Rene Hullum

  • Acute Care Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1619638301
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1065197 Issued in TX
Practice address
3621 22ND St
Lubbock, TX 79410-1301
Phone
(806) 725-7500
NPI assigned
Jan 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1065197 TX Primary
Hospitalist Physician 208M00000X 1065197 TX

Addresses

Primary practice location

3621 22ND St
Lubbock, TX 79410-1301

Mailing address

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220310002276 TX Practitioner - Nurse Practitioner 6406241397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

3621 22ND St
Lubbock, TX 79410-1301
Phone (806) 791-8484

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
  • Covenant Health Hobbs Hospital Hospital, Hobbs, NM, CCN 320065
  • Nor-Lea Hospital District Hospital, Lovington, NM, CCN 321305

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1065197TXMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group Hospitalist CurrentSince Apr 1, 2022 Accepting new patients
Covenant Medical Group CurrentSince Apr 1, 2022 Accepting new patients

Locations

3621 22nd St
Lubbock, TX 79410
Phone (806) 791-8484

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

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 3

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": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1619638301",
    "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": "3621 22ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101301",
            "telephone_number": "806-725-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULLUM",
        "first_name": "LAUREN",
        "middle_name": "RENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1065197",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "1065197",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.