NPIMap

Organization Active NPI

CC Doctors Center Portland, PLLC

  • General Practice Physician
  • Portland, TX
National Provider Identifier
1821544396
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CC DOCTORS CENTER PORTLAND, PLLC
Practice address
125 Northshore Blvd
Portland, TX 78374-4206
Phone
(361) 852-6824
Fax
(361) 814-6828
NPI assigned
Aug 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

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

Authorized official

Name
Dr. James Keith Rose, M.D.NPI 1225192248
Title
President Ceo
Phone
(361) 651-1200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Urgent Care Clinic/Center 261QU0200X J4486 TX

Addresses

Primary practice location

125 Northshore Blvd
Portland, TX 78374-4206

Mailing address

4637 S Padre Island Dr
Corpus Christi, TX 78411-4413
Phone (361) 852-6824

Other names 1

  • The Doctors Center Urgent Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220620000029 TX Part B Supplier - Clinic/Group Practice 8729467956 Receives reassigned benefits from 16 practitioners
Practice locations: Portland, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1821544396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4637 S PADRE ISLAND DR",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784114413",
            "telephone_number": "361-852-6824",
            "fax_number": "361-814-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 NORTHSHORE BLVD",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783744206",
            "telephone_number": "361-852-6824",
            "fax_number": "361-814-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CC DOCTORS CENTER PORTLAND, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-25",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "361-651-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TX",
            "license": "J4486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Doctors Center Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.