NPIMap

Individual provider Active NPI

Subodh K Mallik, M.D.

  • Internal Medicine Physician
  • Fort Stockton, TX
National Provider Identifier
1689628885
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
K4945 Issued in TX
Practice address
387 W Ih 10
Fort Stockton, TX 79735-2700
Phone
(432) 336-0700
Fax
(432) 336-0704
NPI assigned
May 20, 2006
Last updated
Oct 9, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

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 K4945 TX Primary

Addresses

Primary practice location

387 W Ih 10
Fort Stockton, TX 79735-2700

Mailing address

387 W Ih 10
Fort Stockton, TX 79735-2700
Phone (432) 336-0700

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
I20051025000890 TX Practitioner - Internal MedicinePractitioner - Emergency Medicine 5496772808 Reassigns benefits to 4 organizations
Practice locations: Fort Stockton, TX; Odessa, TX

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of WardGroup PAC ID 1456261494, shared by 6 NPIs, 19 clinicians

Practice addresses (Care Compare)

921 E 4TH St
Sandhills Fam Clin E
Monahans, TX 79756-4016
Phone (432) 943-2057

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K4945TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Ward CurrentSince Jan 2, 2018 Accepting new patients
Ess of South Texas LLC CurrentSince May 1, 2016 Accepting new patients
Seminole Hospital District of Gaines County Texas CurrentSince Sep 1, 2017 Accepting new patients
Bir Hospital LLC Current Accepting new patients
County of Ward CurrentSince Jan 26, 2018 Accepting new patients
County of Ward Current Accepting new patients
Seminole Hospital District of Gaines County Texas CurrentSince Sep 1, 2017 Accepting new patients
County of Ward Current Accepting new patients
Midland County Hospital District Past Accepting new patients
Midland County Hospital District Past Accepting new patients
Subodh K Mallik, MD, PA PastSince Oct 13, 2006 Accepting new patients

Locations

387 W Interstate 10
Fort Stockton, TX 79735
Phone (432) 336-2004

1353 N Travis St
Liberty, TX 77575
Phone (936) 336-7316

406 S Gary Ave
Monahans, TX 79756
Phone (432) 943-2511

813 E 4th St
Monahans, TX 79756
Phone (432) 943-2068

921 E 4th St
Monahans, TX 79756
Phone (432) 923-7052

1204 N Mound St
Nacogdoches, TX 75961
Phone (936) 564-4611

209 NW 8th St
Seminole, TX 79360
Phone (432) 758-5811

Interoperability endpoints

  • Direct secure messaging: subodh.mallik.1@13131.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avir at MonahansMonahans, TX, CCN 675522 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2025
Mar 1, 2025
Focused Care at Fort StocktonFort Stockton, TX, CCN 675722 Skilled nursing facility Adp of the SNF Nov 1, 2017
Sandhills Family Clinic EastMonahans, TX, CCN 673475 Rural health clinic Corporate Director
W-2 Managing Employee		 Jan 2, 2018
Jan 2, 2018

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381276800000",
    "number": "1689628885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-0700",
            "fax_number": "432-336-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-0700",
            "fax_number": "432-336-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIK",
        "first_name": "SUBODH",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2013-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K4945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.