Organization Active NPI

Stafford Family Practice PLLC

  • Family Medicine Physician
  • Stafford, TX
National Provider Identifier
1780387092
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STAFFORD FAMILY PRACTICE PLLC
Practice address
203 Brand LN Ste 35
Stafford, TX 77477-5317
Phone
(281) 598-6614
NPI assigned
Mar 24, 2023
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Martin Kay
Title
Administrator
Phone
(866) 439-3165

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

203 Brand LN Ste 35
Stafford, TX 77477-5317

Mailing address

203 Brand LN Ste 35
Stafford, TX 77477-5317
Phone (281) 598-6614

Other practice location 1

705 E Marshall Ave Ste 3001
Longview, TX 75601-5610
Phone (903) 230-9811

Other practice location 2

601 Golder Ave # Uiteb
Odessa, TX 79761-4412
Phone (432) 580-8000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230407001065 TX Part B Supplier - Clinic/Group Practice 3173998028 Receives reassigned benefits from 4 practitioners
Practice locations: Stafford, TX; Odessa, TX; Longview, TX

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2326123Stafford Family Practice203 Brand LN # 35, Stafford, TX 77477Certificate of waiverJun 25, 2027

National Provider Directory

National Provider Directory

Locations

601 Golder Ave
Odessa, TX 79761
Phone (432) 332-1631

203 Brand Ln
Ste 35
Stafford, TX 77477
Phone (281) 598-6614

Practitioners & affiliated clinicians

Practitioners 6

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": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1780387092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 BRAND LN STE 35",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774775317",
            "telephone_number": "281-598-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BRAND LN STE 35",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774775317",
            "telephone_number": "281-598-6614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 E Marshall Ave Ste 3001",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015610",
            "country_code": "US",
            "telephone_number": "903-230-9811",
            "fax_number": "903-653-1431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Golder Ave # Uiteb",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "TX",
            "postal_code": "797614412",
            "country_code": "US",
            "telephone_number": "432-580-8000",
            "fax_number": "281-598-6615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STAFFORD FAMILY PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "KAY",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "866-439-3165"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stafford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; 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.