Individual provider Active NPI

Jose E Elizondo, PAC

  • Physician Assistant
  • Lubbock, TX
National Provider Identifier
1851491518
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03957 Issued in TX
Practice address
2002 Oxford Ave
Lubbock, TX 79410
Phone
(806) 793-8869
Fax
(806) 793-0043
NPI assigned
Sep 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA03957 TX Primary

Addresses

Primary practice location

2002 Oxford Ave
Lubbock, TX 79410

Mailing address

2002 Oxford Ave
Lubbock, TX 79410
Phone (806) 793-8869

Other identifiers 1

IdentifierTypeStateIssuer
P00271695OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040917000931 TX Practitioner - Physician Assistant 6305814336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Joseph J Wolcott MD PAGroup PAC ID 7810248812, 5 clinicians

Practice addresses (Care Compare)

2002 Oxford Ave
Lubbock, TX 79410-1025
Phone (806) 793-8869

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
  • University Medical Center Hospital, Lubbock, TX, CCN 450686
  • Lubbock Heart Hospital LP Hospital, Lubbock, TX, CCN 450876
  • Trustpoint Rehab Hospital of Lubbock Inpatient rehabilitation facility, Lubbock, TX, CCN 673063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA03957TXMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jose.elizondo@direct.myteamcare.com

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1851491518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 OXFORD AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-793-8869",
            "fax_number": "806-793-0043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 OXFORD AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-793-8869",
            "fax_number": "806-793-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "JOSE",
        "middle_name": "E",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00271695",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.