NPIMap

Individual provider Active NPI

Cody Bryan Du Vall, MD

  • Diagnostic Radiology Physician
  • Lufkin, TX
National Provider Identifier
1972555290
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
J6414 Issued in TX
Practice address
505 South John Redditt Drive
Lufkin, TX 75904
Phone
(936) 634-8311
NPI assigned
May 16, 2006
Last updated
May 15, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X J6414 TX Primary

Addresses

Primary practice location

505 South John Redditt Drive
Lufkin, TX 75904

Mailing address

PO Box 1888
Greenville, TX 75403
Phone (800) 945-2455

Other identifiers 1

IdentifierTypeStateIssuer
103617002MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110209000199 TX Practitioner - Diagnostic Radiology 0042376220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical Branch at Galveston, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lufkin Radiology AssociatesGroup PAC ID 8123098704, 3 clinicians

Practice addresses (Care Compare)

505 S John Redditt Dr
Lufkin, TX 75904-3120
Phone (936) 634-8311

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as group
Quality
93.8
Improvement activities
40
Cost
79.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lufkin Radiology Associates Diagnostic Radiology CurrentSince Dec 16, 1994 Accepting new patients

Locations

505 S John Redditt Dr
Lufkin, TX 75904
Phone (713) 512-1200

4920 NE Stallings Dr
Nacogdoches, TX 75965
Phone (936) 568-3441

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1972555290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1888",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "75403",
            "telephone_number": "800-945-2455",
            "fax_number": "903-453-2541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 SOUTH JOHN REDDITT DRIVE",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "75904",
            "telephone_number": "936-634-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DU VALL",
        "first_name": "CODY",
        "middle_name": "BRYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J6414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103617002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lufkin, TX

Sources for this page

Verify at the official NPI Registry.