NPIMap

Organization Active NPI

Permian Nephrology Associates, PA

  • Nephrology Physician
  • Midland, TX
National Provider Identifier
1760596969
Registry record updated Feb 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
F1867 Issued in TX
Legal business name
PERMIAN NEPHROLOGY ASSOCIATES, PA
Practice address
3302 W Golf Course Rd
Suite 100
Midland, TX 79703-5110
Phone
(432) 522-2304
Fax
(432) 522-2307
NPI assigned
Aug 18, 2006
Last updated
Feb 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2012

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

Authorized official

Name
Theresa A Bernal, RHIT, RMA
Title
Office Manager
Phone
(432) 522-2304

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 630161 TX
Nephrology Physician 207RN0300X F1867 TX Primary
Nephrology Physician 207RN0300X G5429 TX

Addresses

Primary practice location

3302 W Golf Course Rd
Suite 100
Midland, TX 79703-5110

Mailing address

P O Box 80279
Midland, TX 79708-0279
Phone (432) 522-2304

Other identifiers 3

IdentifierTypeStateIssuer
0847352-02MedicaidTX
084735202MedicaidTX
CN3681OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

3302 W Golf Course Rd
Ste 100
Midland, TX 79703
Phone (432) 522-2304

4200 W Illinois Ave
Ste 140
Midland, TX 79703
Phone (432) 522-2300

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1760596969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 80279",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797080279",
            "telephone_number": "432-522-2304",
            "fax_number": "432-522-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 W GOLF COURSE RD",
            "address_2": "SUITE 100",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797035110",
            "telephone_number": "432-522-2304",
            "fax_number": "432-522-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERMIAN NEPHROLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "BERNAL",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "432-522-2304",
        "authorized_official_credential": "RHIT, RMA"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "630161",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "F1867",
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "G5429",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0847352-02",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084735202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN3681",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.