Individual provider Active NPI

Laura Mariana Gonzalez Reyes, MD

  • Internal Medicine Physician
  • Odessa, TX
National Provider Identifier
1639817000
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
V3866 Issued in TX
Practice address
701 W 5TH St
Odessa, TX 79763-4206
Phone
(432) 703-5375
NPI assigned
May 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BP10080571 TX
Internal Medicine Physician 207R00000X V3866 TX Primary

Addresses

Primary practice location

701 W 5TH St
Odessa, TX 79763-4206

Mailing address

701 W 5TH St
Odessa, TX 79763-4206
Phone (432) 703-5375

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
I20241125000749 TX Practitioner - Internal Medicine 6204217839 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Medical Group of Texas PLLCGroup PAC ID 7810117223, 319 clinicians

Practice addresses (Care Compare)

1500 S Sunset Ave
Littlefield, TX 79339-4899
Phone (806) 385-6411

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10080571TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Oncology PA CurrentSince Oct 15, 2024 Accepting new patients
Lamb Healthcare Center CurrentSince May 1, 2025 Accepting new patients
Texas Oncology PA CurrentSince Oct 15, 2024 Accepting new patients
Lamb Healthcare Center CurrentSince May 1, 2025 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Nov 3, 2024 Accepting new patients

Locations

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

1500 S Sunset Ave
Littlefield, TX 79339
Phone (806) 385-6411

400 Rosalind Redfern Grover Pkwy
Ste 100
Midland, TX 79701
Phone (432) 687-1949

701 W 5th St
Odessa, TX 79763
Phone (432) 335-2222

Organizations & group practices 5

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 2

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": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1639817000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-703-5375"
        },
        {
            "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": "432-703-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ REYES",
        "first_name": "LAURA",
        "middle_name": "MARIANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10080571",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "V3866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.