Active NPI
William Nisimblat, MD
- Pediatrics Physician
- Alice, TX
National Provider Identifier
1700979739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D8368
- Practice address
- 305 E 3Rd St
Alice, TX 78332-4705 - Phone
- (361) 664-5291
- Fax
- (361) 668-1630
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D8368 | TX | Primary |
Addresses
Primary practice location
305 E 3Rd St
Alice, TX 78332-4705
Mailing address
PO Box 289
Alice, TX 78333
Phone (361) 664-5291
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1214496-03 | Other | TX | TESAS HEALTH STEPS |
| 121449601 | Medicaid | TX | |
| 121449602 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8368 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297209600000",
"number": "1700979739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 289",
"city": "ALICE",
"state": "TX",
"postal_code": "78333",
"telephone_number": "361-664-5291",
"fax_number": "361-668-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 E 3RD ST",
"city": "ALICE",
"state": "TX",
"postal_code": "783324705",
"telephone_number": "361-664-5291",
"fax_number": "361-668-1630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISIMBLAT",
"first_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2011-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "D8368",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TESAS HEALTH STEPS",
"identifier": "1214496-03",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121449601",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121449602",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alice, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.