NPIMap

Individual provider Active NPI

Rebecca E Raedeke, MD

  • Internal Medicine Physician
  • Lubbock, TX
National Provider Identifier
1679680938
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H4304 Issued in TX
Practice address
4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520
Phone
(806) 744-7223
Fax
(806) 740-3325
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H4304 TX Primary

Addresses

Primary practice location

4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520

Mailing address

2804 N Loop 289
Lubbock, TX 79415-1410
Phone (806) 744-7223

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rraedeke1250182@oc.providencedirect.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040901000081 TX Practitioner - Internal Medicine 9234042169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Texas Tech University Health Science Center School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grace Clinic of LubbockGroup PAC ID 5597768101, 44 clinicians

Practice addresses (Care Compare)

4515 Marsha Sharp Fwy
Lubbock, TX 79407-2520
Phone (806) 744-7223

Hospital & facility affiliations

  • Calvert Home Health Care, LLC Home health agency, Lubbock, TX, CCN 677109
  • Beyondfaith Homecare & Rehab LLC Home health agency, Lubbock, TX, CCN 679374
  • Grace Surgical Hospital Hospital, Lubbock, TX, CCN 450162
  • Covenant Childrens Hospital Hospital, Lubbock, TX, CCN 453306
  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
  • University Medical Center Hospital, Lubbock, TX, CCN 450686

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Clinic of Lubbock Internal Medicine CurrentSince Jul 31, 2017 Accepting new patients
Grace Clinic of Lubbock CurrentSince Jul 31, 2017 Accepting new patients

Locations

4515 Marsha Sharp Fwy
Lubbock, TX 79407
Phone 80674472232432

2804 N Loop 289
Lubbock, TX 79415
Phone (806) 740-3363

Interoperability endpoints

  • Direct secure messaging: rraedeke1250182@oc.providencedirect.org

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 10

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": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1679680938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 N LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794151410",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 MARSHA SHARP FWY",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794072520",
            "telephone_number": "806-744-7223",
            "fax_number": "806-740-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAEDEKE",
        "first_name": "REBECCA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H4304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rraedeke1250182@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4515 Marsha Sharp Fwy",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794072520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.