NPIMap

Organization Active NPI

Privia Medical Group West Texas, PLLC

Doing business as Abilene Diagnostic Clinics

  • Podiatrist
  • Abilene, TX
National Provider Identifier
1912149758
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PRIVIA MEDICAL GROUP WEST TEXAS, PLLC
Doing business as
Abilene Diagnostic Clinics
West Texas Health
Practice address
1665 Antilley Rd Ste 240
Abilene, TX 79606-5274
Phone
(325) 437-2001
Fax
(325) 437-2011
NPI assigned
Mar 25, 2009
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Andrew Kouba
Title
Ceo
Phone
(325) 437-8645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

1665 Antilley Rd Ste 240
Abilene, TX 79606-5274

Mailing address

PO Box 5409
Abilene, TX 79608-5409
Phone (325) 437-8655

Other practice location 1

1665 Antilley Rd Ste 230
Abilene, TX 79606-5291
Phone (325) 437-2001

Other names 2

  • Abilene Diagnostic Clinics Doing business as
  • West Texas Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930082940 TX DME Supplier - Physician - Podiatry 5597747378 Practice locations: Abilene, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northside Temp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1912149758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5409",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796085409",
            "telephone_number": "325-437-8655",
            "fax_number": "325-437-8647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 ANTILLEY RD STE 240",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065274",
            "telephone_number": "325-437-2001",
            "fax_number": "325-437-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1665 Antilley Rd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Abilene",
            "state": "TX",
            "postal_code": "796065291",
            "country_code": "US",
            "telephone_number": "325-437-2001",
            "fax_number": "325-437-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WEST TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "KOUBA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "325-437-8645"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abilene Diagnostic Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Texas Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abilene, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.