ODESSA ACUTE TRAUMA PLLC (NPI# 1982943726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982943726 |
| Entity Type | Organization |
| Organization Name | ODESSA ACUTE TRAUMA PLLC |
| Practice Address |
500 W 4th St Odessa TX 79761-5001 |
| Mailing Address |
13737 Noel Rd Suite 1600 Dallas TX 75240-1331 |
| Practice Telephone | 4323327500 |
| Practice Fax Number | 4323327503 |
| Mailing Telephone | 4694012386 |
| Mailing Fax Number | 2147122444 |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2014-01-24 |
| Authorized Official Name | WILLIAM JERNBERG (ENROLLMENT) |
| Authorized Official Telephone | 4694012386 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 2086S0127X |
Surgery Specialization: Trauma Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
500 W 4TH ST |
| City | ODESSA |
| State | TX |
| Zip Code | 79761-5001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033113808 | Bruce Carl Becker II | Family Medicine | 500 W 4th St, Odessa, TX 79761-5001 | 2005-06-09 |
| 1033724000 | Hannah Brooke Lineberry | Pharmacist | 500 W 4th St, Odessa, TX 79761-5059 | 2020-09-15 |
| 1376164673 | Kayal Kanni Dhevi Chandramohan | Dietitian, Registered | 500 W 4th St, Odessa, TX 79761-5001 | 2020-04-28 |
| 1669009643 | Phillip Cook | Pharmacist | 500 W 4th St, Odessa, TX 79761-5001 | 2020-03-27 |
| 1609406560 | Alan Robinson | Nurse Anesthetist, Certified Registered | 500 W 4th St, Odessa, TX 79761-5001 | 2020-01-20 |
| 1447899679 | Olivia Ortiz | Nurse Practitioner | 500 W 4th St, Odessa, TX 79761-5001 | 2020-01-06 |
| 1780227280 | Chasity Ann Young | Physician Assistant | 500 W 4th St, Odessa, TX 79761-5001 | 2019-10-28 |
| 1720639776 | Candy Bowen | Nurse Practitioner | 500 W 4th St, Odessa, TX 79761-5001 | 2019-09-21 |
| 1548826100 | Lakshmi Praveena Alahari | Student in an Organized Health Care Education/Training Program | 500 W 4th St, Odessa, TX 79761-5001 | 2019-05-18 |
| 1215498944 | Christi Michelle Tucker | Nurse Practitioner | 500 W 4th St, Odessa, TX 79761-5001 | 2019-03-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407482003 | Endovascular Lab Pllc | Surgery | 612 N Washington Avenue, Suite 100, Odessa, TX 79761 | 2020-03-16 |
| 1235627605 | Megan Elizabeth Lemond | Pediatrics | 912 E 5th St, Odessa, TX 79761 | 2018-05-01 |
| 1922522630 | Brian W Griffin | Nurse Practitioner | 4606 Fountain Ln., Odessa, TX 79761 | 2017-08-03 |
| 1023540507 | Florenda De Guzman | Nurse Practitioner | 405 N Tom Green, Odessa, TX 79761 | 2017-04-03 |
| 1205378239 | Scotty R Ortega Md | Clinical Nurse Specialist | 2487 E 11th Street, Odessa, TX 79761 | 2016-11-08 |
| 1487094355 | Marivel Perez | Nurse Practitioner | 540 W 5th St Ste 350, Ste. 350, Odessa, TX 79761 | 2013-06-25 |
| 1245579804 | Accurate Health Care LLC | Home Health | 302 Industrial Ave, Odessa, TX 79761 | 2013-02-01 |
| 1437421666 | Mary Magdalene Garcia | Speech-Language Pathologist | 620 N. Alleghaney, Odessa, TX 79761 | 2012-02-03 |
| 1841576378 | Ashley Burdex | Family Medicine | 6030 W University, Odessa, TX 79761 | 2011-10-28 |
| 1730465428 | Therese A Archer | Massage Therapist | 712 N. Texas Ave, Odessa, TX 79761 | 2011-10-26 |
| Find all providers in zip 79761 | ||||
| Taxonomy Code | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699835504 | Mark Lieser | Surgery | 540 W 5th St, 350, Odessa, TX 79761-5034 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174034623 | Stat Trauma & Surgical Services, Pllc | Surgery | 6 Garden Ln, Arlington, TX 76016 | 2017-10-23 |
| 1487164604 | Urgent Specialty Associates Pllc | Surgery | 4100 Spring Valley Rd Ste 250, Farmers Branch, TX 75244-3645 | 2017-10-02 |
| 1578969788 | Advanced Fracture Care Solutions Pllc | Surgery | 2145 Sutton Pl, Plano, TX 75093-4323 | 2014-11-16 |
| 1952737371 | Ernest A Gonzalez Md Pa | Surgery | 12319 N Mopac Expy Ste 350, Austin, TX 78758-2512 | 2013-09-17 |
| 1831393735 | Alexander Laurance Eastman | Surgery | 5323 Harry Hines Blvd # Mc9158, Department of Surgery--btcc, Dallas, TX 75390-9158 | 2007-06-13 |
| 1669592242 | Surgical Consultants Pa | Surgery | 6210 Wooldridge Rd Ste A, Corpus Christi, TX 78414-2528 | 2007-03-29 |
| 1144240508 | Ted R. Smith | Surgery | 50 Hillcrest Medical Blvd Ste 105, Waco, TX 76712-8953 | 2006-07-20 |
| 1750310520 | Matthew A Lovitt | Surgery | 2710 Swiss Avenue, Dallas, TX 75204-5900 | 2006-07-02 |
| 1730115270 | Jimie Dianne Owsley | Surgery | 810 Morgan Ave Apt 1, Corpus Christi, TX 78404-2058 | 2006-06-25 |
| 1578500815 | Advanced Laparoendoscopic Surgery, Pllc | Surgery | 3005 West Loop S, Suite 225, Houston, TX 77027-6100 | 2006-06-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.