Individual provider Active NPI

Lorena Mata Juarez, M.D.

  • Internal Medicine Physician
  • Galveston, TX
National Provider Identifier
1861139404
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
V7573 Issued in TX
Practice address
400 Harborside Dr Ste 105-107
Galveston, TX 77555-0001
Phone
(409) 747-1883
NPI assigned
May 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X V7573 TX Primary

Addresses

Primary practice location

400 Harborside Dr Ste 105-107
Galveston, TX 77555-0001

Mailing address

Jr. Piura 180
Lima, LIMA 15373
PE

Other practice location 1

Berkshire Medical Center
725 North Street
Pittsfield, MA 04201
Phone (413) 447-2322

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250509002788 TX Practitioner - Internal Medicine 5193242311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

400 Harborside Dr
Suite 105 107
Galveston, TX 77555-0001
Phone (409) 747-1883

Hospital & facility affiliations

  • University of Texas Medical Branch Galveston Hospital, Galveston, TX, CCN 450018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients

Locations

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

Interoperability endpoints

  • Direct secure messaging: lmatajuarez88347@direct.utmb.edu

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 1

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": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1861139404",
    "addresses": [
        {
            "country_code": "PE",
            "country_name": "Peru",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "JR. PIURA 180",
            "city": "LIMA",
            "state": "LIMA",
            "postal_code": "15373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HARBORSIDE DR STE 105-107",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550001",
            "telephone_number": "409-747-1883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Berkshire Medical Center",
            "address_2": "725 North Street",
            "address_purpose": "LOCATION",
            "city": "Pittsfield",
            "state": "MA",
            "postal_code": "04201",
            "country_code": "US",
            "telephone_number": "413-447-2322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATA JUAREZ",
        "first_name": "LORENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "V7573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

Verify at the official NPI Registry.