Active NPI
Joseph E Sudolcan, MD
- Family Medicine Physician
- Big Lake, TX
National Provider Identifier
1811954332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- H0859
- Practice address
- 800 N Main Ave Ste 3
Big Lake, TX 76932-3900 - Phone
- (325) 884-3743
- NPI assigned
- Apr 27, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | H0859 | TX | Primary |
Addresses
Primary practice location
800 N Main Ave Ste 3
Big Lake, TX 76932-3900
Mailing address
3555 Knickerbocker Rd
San Angelo, TX 76904-7610
Phone (325) 949-9555
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83X714 | Other | TX | BLUE CROSS/BLUE SHIELD TX |
| 138407509 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0859 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reagan Hospital District | 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.
-
- Nursing Facility/Intermediate Care Facility
- Big Lake, TX
- NPI 1659336840
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328227200000",
"number": "1811954332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3555 KNICKERBOCKER RD",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769047610",
"telephone_number": "325-949-9555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N MAIN AVE STE 3",
"city": "BIG LAKE",
"state": "TX",
"postal_code": "769323900",
"telephone_number": "325-884-3743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUDOLCAN",
"first_name": "JOSEPH",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2012-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "H0859",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD TX",
"identifier": "83X714",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "138407509",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.