Active NPI
Elise Lopez
- Family Medicine Physician
- Waco, TX
National Provider Identifier
1710673769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MED-PHYS-LIC-174527
- Practice address
- 1600 Providence Dr
Waco, TX 76707-2261 - Phone
- (254) 313-4418
- NPI assigned
- Apr 13, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MED-PHYS-LIC-174527 | MT | Primary |
Addresses
Primary practice location
1600 Providence Dr
Waco, TX 76707-2261
Mailing address
1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4418
Other practice location 1
600 Mt Highway 91 S
Dillon, MT 59725-7379
Phone (406) 683-3000
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260224004203 | TX | Order and Referring Only - Family Practice | 4082195326 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784505600000",
"number": "1710673769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 PROVIDENCE DR",
"city": "WACO",
"state": "TX",
"postal_code": "767072261",
"telephone_number": "254-313-4418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 PROVIDENCE DR",
"city": "WACO",
"state": "TX",
"postal_code": "767072261",
"telephone_number": "254-313-4418"
}
],
"practiceLocations": [
{
"address_1": "600 Mt Highway 91 S",
"address_purpose": "LOCATION",
"city": "Dillon",
"state": "MT",
"postal_code": "597257379",
"country_code": "US",
"telephone_number": "406-683-3000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LOPEZ",
"first_name": "ELISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-13",
"last_updated": "2026-07-20",
"certification_date": "2026-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MT",
"license": "MED-PHYS-LIC-174527",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.