Acton Medical Clinic PA
Organization Active NPI Family Medicine Physician · Granbury, TX
NPI 1619928397 · NPPES record last updated Aug 16, 2012
Key facts
- NPI
- 1619928397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ACTON MEDICAL CLINIC PA
- Practice address
- 2006 Fall Creek Hwy
Granbury, TX 76049-7913 - Phone
- (817) 326-3440
- NPI assigned
- May 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Paul Stephen Bishop, DO
- Title
- Owner
- Phone
- (817) 326-3440
Practitioners 11
-
Richard L Neckar, APN
-
Lyndi Armstrong, APRN-CNP
-
David Edward Blocker, MD, MPH
-
Amber R Lavender, FNP
-
Vanessa Amanda Price, APRN-CNP
-
Summer D Cumba, PA
-
Adaobi Moemenam, NP
-
Shellie Diane Shepherd, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0932596 | Acton Medical Clinic | Certificate of waiver | Feb 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041204000150 | TX | Part B Supplier - Clinic/Group Practice | 1254397961 |
Receives reassigned benefits from 11 practitioners Practice locations: Granbury, TX; Irving, TX |
National Provider Directory
Locations
2331 W Shady Grove Rd
Irving, TX 75060
2331 W Shady Grove Rd
#100
Irving, TX 75060
Phone (817) 326-3440
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BABHBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2006 Fall Creek Hwy
Granbury, TX 76049-7913
Mailing address
PO Box 5334
Granbury, TX 76049-0334
Phone (817) 326-3440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD0227 | Other | MEDICARE RR GROUP NUMBER | |
| 00298R | Other | TX | BCBS GROUP NUMBER |
| 142421001 | Medicaid | TX |
Other providers in Granbury, TX
- 5M Enterprises
- Tomas E. Abaray
- Richard Michael Adams
- Advanced Medical Enterprises LP
- Advantage Medical Equipment
- Aegis Group Practice LLC
- Seili Jancy Afflerbach
All providers in Granbury, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.