Active NPI
Douglass John Wacker, C.P.O.
- Prosthetist
- Houston, TX
National Provider Identifier
1790927192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- 85
- Practice address
- 3900 La Branch St
Houston, TX 77004-4046 - Phone
- (713) 524-3949
- Fax
- (713) 524-3915
- NPI assigned
- Mar 31, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | 85 | TX | Primary |
| Orthotist | 222Z00000X | 85 | TX |
Addresses
Primary practice location
3900 La Branch St
Houston, TX 77004-4046
Mailing address
3900 La Branch St
Houston, TX 77004-4046
Phone (713) 524-3949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PO0012 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85 | TX | MD | Prosthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Muilenburg Prosthetics, Inc. | Prosthetist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480464000000",
"number": "1790927192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 LA BRANCH ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770044046",
"telephone_number": "713-524-3949",
"fax_number": "713-524-3915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 LA BRANCH ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770044046",
"telephone_number": "713-524-3949",
"fax_number": "713-524-3915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACKER",
"first_name": "DOUGLASS",
"middle_name": "JOHN",
"credential": "C.P.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-31",
"last_updated": "2016-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "TX",
"license": "85",
"primary": true
},
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "TX",
"license": "85",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PO0012",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.