Organization Active NPI

Lufkin Adult Medicine Clinic

  • Clinic/Center
  • Lufkin, TX
National Provider Identifier
1689738338
Registry record updated Jan 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
LUFKIN ADULT MEDICINE CLINIC
Practice address
202 S Bynum St
Lufkin, TX 75904-3913
Phone
(936) 632-9277
Fax
(936) 632-9285
NPI assigned
Dec 20, 2006
Last updated
Jan 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2011

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

Authorized official

Name
Dr. Samuel S Santiago, MDNPI 1689684227
Title
President
Phone
(936) 632-9277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

202 S Bynum St
Lufkin, TX 75904-3913

Mailing address

202 S Bynum St
Lufkin, TX 75904-3913
Phone (936) 632-9277

Other identifiers 1

IdentifierTypeStateIssuer
142942501MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060126000923 TX Part B Supplier - Clinic/Group Practice 7315951555 Receives reassigned benefits from 2 practitioners
Practice locations: Lufkin, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0991881Lufkin Adult Medicine Clinic202 S Bynum Street, Lufkin, TX 75904Certificate of waiverOct 1, 2027

National Provider Directory

National Provider Directory

Locations

710 Gaslight Blvd
#D
Lufkin, TX 75904
Phone (936) 632-9277

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11715/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295308800000",
    "number": "1689738338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 S BYNUM ST",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043913",
            "telephone_number": "936-632-9277",
            "fax_number": "936-632-9285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S BYNUM ST",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043913",
            "telephone_number": "936-632-9277",
            "fax_number": "936-632-9285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUFKIN ADULT MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2011-01-18",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-632-9277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142942501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lufkin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.