Individual provider Active NPI

Clint Wes Hacker, PT

  • Physical Therapist
  • Lubbock, TX
National Provider Identifier
1619971009
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT1149186 Issued in TX
Practice address
6202 82ND St
Lubbock, TX 79424-3691
Phone
(806) 687-8008
Fax
(806) 687-8009
NPI assigned
Jun 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT1149186 TX Primary

Addresses

Primary practice location

6202 82ND St
Lubbock, TX 79424-3691

Mailing address

2431 S Loop 289
Lubbock, TX 79423-1519
Phone (806) 771-8008

Other identifiers 5

IdentifierTypeStateIssuer
171677100OtherTXFIRSTCARE
219905101MedicaidTX
219905102MedicaidTX
8T3268OtherTXBLUE CROSS BLUE SHIELD
P00451766OtherTXMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050317000659 TX Practitioner - Physical Therapist in Private Practice 8628023132 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Today of Lubbock LPGroup PAC ID 7315836053, 47 clinicians

Practice addresses (Care Compare)

6202 82ND St
Lubbock, TX 79424-3691
Phone (806) 687-8008

Merit-based Incentive Payment System (MIPS)

Final score
72.17 of 100Reported as group
Quality
45.78
Promoting interoperability
92
Improvement activities
40
Cost
68.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT1149186TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Today of Lubbock, LP Physical Therapist CurrentSince Jan 10, 2005 Accepting new patients
Physical Therapy Today of Lubbock LP Physical Therapist CurrentSince Jan 10, 2005 Accepting new patients
Midland Physical Therapy and Sports Rehabilitation Inc Physical Therapist CurrentSince Dec 1, 2024 Accepting new patients

Locations

1506 S Sunset Ave
Ste B
Littlefield, TX 79339
Phone (806) 368-5374

12706 Indiana Ave
Ste 300
Lubbock, TX 79423
Phone (806) 993-5041

2431 S Loop 289
Lubbock, TX 79423
Phone (806) 771-7661

5020 122nd St
Ste 200
Lubbock, TX 79424
Phone (806) 705-7239

4138 19th St
Lubbock, TX 79407
Phone (806) 780-2329

6202 82nd St
Lubbock, TX 79424
Phone (806) 687-8008

2420 W Illinois Ave
Midland, TX 79701
Phone (432) 687-0235

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352937600000",
    "number": "1619971009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 S LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231519",
            "telephone_number": "806-771-8008",
            "fax_number": "806-771-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6202 82ND ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243691",
            "telephone_number": "806-687-8008",
            "fax_number": "806-687-8009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "CLINT",
        "middle_name": "WES",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2012-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "PT1149186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "171677100",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219905101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219905102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8T3268",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00451766",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.