NPIMap

Organization Active NPI

CSK Medical Partners

Doing business as Lubbock Sports Medicine Associates

  • Specialist
  • Lubbock, TX
National Provider Identifier
1902842404
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CSK MEDICAL PARTNERS
Doing business as
Lubbock Sports Medicine Associates
Practice address
4110 22ND PL
Lubbock, TX 79410-1122
Phone
(806) 792-4329
Fax
(806) 792-9466
NPI assigned
Jun 22, 2006
Last updated
Jun 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

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

Authorized official

Name
Mr. Robert Thomas Hendricks
Title
Administrator
Phone
(806) 792-4329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

4110 22ND PL
Lubbock, TX 79410-1122

Mailing address

4110 22ND PL
Lubbock, TX 79410-1122
Phone (806) 792-4329

Other identifiers 2

IdentifierTypeStateIssuer
0472270001OtherDMERC
0080EHOtherBLUE CROSS/BLUE SHIELD OF TEXAS

Other names 1

  • Lubbock Sports Medicine Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050413000186 TX Part B Supplier - Clinic/Group Practice 2466404447 Receives reassigned benefits from 28 practitioners
1 other NPI on this enrollment
Practice locations: Lubbock, TX
O20100930054762 TX DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2466404447 Practice locations: Lubbock, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1028036Lubbock Sports Medicine Associates4110 22ND Place, Lubbock, TX 79410Certificate of waiverJul 19, 2026

National Provider Directory

National Provider Directory

Locations

5044 Frankford Ave
Ste 100
Lubbock, TX 79424
Phone (806) 792-7200

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340841600000",
    "number": "1902842404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 22ND PL",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101122",
            "telephone_number": "806-792-4329",
            "fax_number": "806-792-9466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 22ND PL",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101122",
            "telephone_number": "806-792-4329",
            "fax_number": "806-792-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CSK MEDICAL PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2012-06-28",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "806-792-4329",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0472270001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF TEXAS",
            "identifier": "0080EH",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lubbock Sports Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.