NPIMap

Individual provider Active NPI

Walter C Brogan III, MD

  • Cardiovascular Disease Physician
  • Lubbock, TX
National Provider Identifier
1811069339
Registry record updated Sep 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
H9305 Issued in TX
Practice address
4802 N Loop 289
Lubbock, TX 79416-3025
Phone
(806) 788-0040
Fax
(806) 788-0015
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 6

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Cardiovascular Disease (Cardiology)
Education
West Virginia University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Seminole Hospital District of Gaines County Texas (17 clinicians)
Texas Physicians Group (9 clinicians)

Practice addresses (Care Compare)

209 NW 8TH St
Seminole, TX 79360-3447
Phone (915) 758-5811

4802 N Loop
Suite 289
Lubbock, TX 79416-3025
Phone (806) 788-0040

Hospital & facility affiliations

  • Excelacare Home Health Home health agency · Lubbock, TX · CCN 677566
  • Lubbock Heart Hospital LP Hospital · Lubbock, TX · CCN 450876
  • Covenant Medical Center Hospital · Lubbock, TX · CCN 450040
  • Memorial Hospital Hospital · Seminole, TX · CCN 451358
  • Grace Surgical Hospital Hospital · Lubbock, TX · CCN 450162
  • University Medical Center Hospital · Lubbock, TX · CCN 450686

Merit-based Incentive Payment System (MIPS)

Final score
78.78 of 100 (group)
Quality
65.69
Promoting interoperability
100
Improvement activities
40
Cost
63.56

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting24
Pacemaker insertion or repair1-10

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20050615000123 TX Practitioner - Cardiovascular Disease (Cardiology) 5092759613 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Physicians Group Cardiovascular Disease Current
since Feb 1, 2015		 Accepting new patients
Covenant Health System Past Accepting new patients

Locations

4802 N Loop 289
Lubbock, TX 79416
Phone (806) 788-0004

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24018/brand/1/csg/1/fhir/r4
  • Direct secure messaging: walter.brogan.1@24018.direct.athenahealth.com

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X H9305 TX Primary

Addresses

NPPES NPI Registry

Primary practice location

4802 N Loop 289
Lubbock, TX 79416-3025

Mailing address

4802 N Loop 289
Lubbock, TX 79416-3025
Phone (806) 788-0040

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
134958107MedicaidTX

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 8, 2017.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504828800000",
    "number": "1811069339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 N LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794163025",
            "telephone_number": "806-788-0040",
            "fax_number": "806-788-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 N LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794163025",
            "telephone_number": "806-788-0040",
            "fax_number": "806-788-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGAN",
        "first_name": "WALTER",
        "middle_name": "C",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2017-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "H9305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134958107",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.