Individual provider Active NPI

Joel Brennan Mahan, M.D.

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1720239106
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N0937 Issued in TX
Practice address
609 Elm Ave
Waco, TX 76704
Phone
(254) 313-6900
Fax
(254) 313-6959
NPI assigned
Oct 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N0937 TX Primary

Addresses

Primary practice location

609 Elm Ave
Waco, TX 76704

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 1

IdentifierTypeStateIssuer
200061401MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090130000387 TX Practitioner - Family Practice 8426112764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heart of Texas Community Health Center, Inc.Group PAC ID 1153370242, 106 clinicians

Practice addresses (Care Compare)

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Hospital & facility affiliations

  • Ascension Providence Hospital, Waco, TX, CCN 450042
  • Baylor Scott & White Medical Center Hillcrest Hospital, Waco, TX, CCN 450101

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Community Health Center, Inc Family Medicine CurrentSince May 3, 2018 Accepting new patients
Heart of Texas Community Health Center Inc Current Accepting new patients
Heart of Texas Community Health Center, Inc. Family Medicine CurrentSince May 3, 2018 Accepting new patients

Locations

1600 Providence Dr
Waco, TX 76707
Phone (254) 313-4200

609 Elm Ave
Waco, TX 76704
Phone (254) 313-6900

Organizations & group practices 3

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 2

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": "1222992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457654400000",
    "number": "1720239106",
    "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": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 ELM AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76704",
            "telephone_number": "254-313-6900",
            "fax_number": "254-313-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "JOEL",
        "middle_name": "BRENNAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-03",
        "last_updated": "2016-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200061401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.