NPIMap

Individual provider Active NPI

Joel Brian Landry, MD

  • Family Medicine Physician
  • Lubbock, TX
National Provider Identifier
1982669719
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K5595 Issued in TX
Practice address
4102 24TH Street Suite 101
Lubbock, TX 79410
Phone
(806) 797-4422
Fax
(806) 799-1817
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K5595 TX Primary

Addresses

Primary practice location

4102 24TH Street Suite 101
Lubbock, TX 79410

Mailing address

3420 22ND Place
Lubbock, TX 79410
Phone (806) 725-7800

Other identifiers 1

IdentifierTypeStateIssuer
141107601MedicaidTX

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
I20110421000075 TX Practitioner - Family Practice 3678758497 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

2215 Nashville Ave
Lubbock, TX 79410-1105
Phone (806) 725-5844

3601 21St St
Lubbock, TX 79410-1229
Phone (806) 791-0399

4015 22ND PL
Lubbock, TX 79410-1119
Phone (806) 725-0015

5915 82ND St
Lubbock, TX 79424-3673
Phone (806) 794-3000

611 N Frankford Ave
Lubbock, TX 79416-1545
Phone (806) 725-5480

9812 Slide Rd
Lubbock, TX 79424-5781
Phone (806) 725-8400

Hospital & facility affiliations

  • Direct Health Care Inc Home health agency, Lubbock, TX, CCN 677264
  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
  • Covenant Childrens Hospital Hospital, Lubbock, TX, CCN 453306
  • University Medical Center Hospital, Lubbock, TX, CCN 450686
  • Grace Surgical Hospital Hospital, Lubbock, TX, CCN 450162
  • Lamb Healthcare Center Hospital, Littlefield, TX, CCN 450698

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group Family Medicine CurrentSince Jul 1, 2000 Accepting new patients
Covenant Medical Group Family Medicine CurrentSince Jul 1, 2000 Accepting new patients

Locations

4102 24th St
Ste 101
Lubbock, TX 79410
Phone (806) 788-1111

3420 22nd Pl
Lubbock, TX 79410
Phone (806) 725-1800

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

5915 82nd St
Lubbock, TX 79424
Phone (806) 794-3000

Organizations & group practices 2

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 10

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1982669719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 22ND PLACE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-725-7800",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 24TH STREET SUITE 101",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79410",
            "telephone_number": "806-797-4422",
            "fax_number": "806-799-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "JOEL",
        "middle_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K5595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141107601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.