Individual provider Active NPI

Elizabeth Manne Ulliman, M.D.

  • Internal Medicine Physician
  • Temple, TX
National Provider Identifier
1750646717
Registry record updated May 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
R73480 Issued in AZ
Practice address
2401 S 31St St
Temple, TX 76508-0001
Phone
(254) 724-7633
Fax
(254) 724-9280
NPI assigned
Jul 5, 2012
Last updated
May 16, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R73480 AZ Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-0001

Mailing address

2401 S 31St St
Temple, TX 76508-0001
Phone (254) 724-7633

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
I20170929001826 TX Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 8123309309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Ips LLCGroup PAC ID 9638356801, 44 clinicians

Practice addresses (Care Compare)

1434 E Sonterra Blvd
Suite 210
San Antonio, TX 78258-4973
Phone (210) 690-7400

34910 Interstate 10 W 601
Boerne, TX 78006-9230
Phone (830) 248-1207

4458 Medical Dr
Suite 505
San Antonio, TX 78229-3748
Phone (210) 690-7400

4499 Medical Dr
Suite 150
San Antonio, TX 78229-3735
Phone (210) 690-7400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
72.15 of 100Reported as individual
Quality
79.43
Improvement activities
0
Cost
75.12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R73480AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC CurrentSince Jul 7, 2017 Accepting new patients
Texas Ips LLC CurrentSince Jan 1, 2018 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Jul 7, 2017 Accepting new patients

Locations

1500 E Houston St
Beeville, TX 78102
Phone (361) 354-2000

34910 Interstate 10 W
Ste 601
Boerne, TX 78006
Phone (830) 248-1207

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

1434 E Sonterra Blvd
Ste 210
San Antonio, TX 78258
Phone (210) 481-3119

4458 Medical Dr
Ste 505
San Antonio, TX 78229

4499 Medical Dr
#150
San Antonio, TX 78229
Phone (210) 614-8181

305 N McKinney St
Sweeny, TX 77480
Phone (979) 548-1500

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431734400000",
    "number": "1750646717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-7633",
            "fax_number": "254-724-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-7633",
            "fax_number": "254-724-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLIMAN",
        "first_name": "ELIZABETH",
        "middle_name": "MANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-05",
        "last_updated": "2015-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "R73480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.