NPIMap

Organization Active NPI

Star Formula Inc

  • Durable Medical Equipment & Medical Supplies
  • El Paso, TX
National Provider Identifier
1720554108
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
STAR FORMULA INC
Practice address
1477 Lomaland Dr Ste B1
El Paso, TX 79935-4704
Phone
(915) 213-6995
Fax
(915) 564-5548
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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

Authorized official

Name
Jennifer J Mitchell
Title
Owner
Phone
(972) 380-2065

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X

Addresses

Primary practice location

1477 Lomaland Dr Ste B1
El Paso, TX 79935-4704

Mailing address

4386 Sunbelt Dr
Addison, TX 75001-5611
Phone (800) 368-2065

Other names 1

  • Star Medical Specialties Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181127003427 TX DME Supplier - Medical Supply Company 8123391521 1 other NPI on this enrollment
Practice locations: El Paso, TX

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Star Medical Specialties1477 Lomaland Dr, El Paso, TX 79935-4704(915) 213-6995 Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ultraviolet Light Devices and/or Supplies|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment and/or Supplies|Respiratory Suction Pumps|Surgical Dres… Accepts assignmentParticipating since Sep 8, 2017

National Provider Directory

National Provider Directory
Tax ID family
Star Formula Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1720554108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4386 SUNBELT DR",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750015611",
            "telephone_number": "800-368-2065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1477 LOMALAND DR STE B1",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799354704",
            "telephone_number": "915-213-6995",
            "fax_number": "915-564-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR FORMULA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-380-2065"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Medical Specialties",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Star Medical Specialties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.