ILLUMINATE MEDICAL GROUP PLLC (NPI# 1679036891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679036891 |
| Entity Type | Organization |
| Organization Name | ILLUMINATE MEDICAL GROUP PLLC |
| Practice Address |
1028 Truman Rd Lantana TX 76226-4395 |
| Practice Telephone | 9402209996 |
| Mailing Telephone | 9402209996 |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2019-04-14 |
| Authorized Official Name | DR. MATTHEW B ROBERSON (OWNER / CEO) |
| Authorized Official Telephone | 9402209996 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1028 TRUMAN RD |
| City | LANTANA |
| State | TX |
| Zip Code | 76226-4395 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528666153 | Rapid Med Argyle | Clinic/Center | 391 Us Highway 377, Argyle, TX 76226 | 2020-10-15 |
| 1083259139 | Vivid Performance Physical Therapy | Physical Therapist | 1517 15th Street, Northlake, TX 76226 | 2019-11-13 |
| 1760959480 | Ben E. Dickerson | Counselor | 9477 Fort Worth Drive, Denton, TX 76226 | 2018-10-31 |
| 1376018226 | Pm Partnership Pllc | Dentist | 1500 Commons Circle, Suite 100, Northlake, TX 76226 | 2018-10-08 |
| 1982183604 | Mark Andrew Sams | Counselor | 1413 Rolling Acres Dr, Argyle, TX 76226 | 2018-08-13 |
| 1164900874 | Staci Durik | Psychologist | 2300 Chipping Campden Rd, Argyle, TX 76226 | 2018-08-03 |
| 1396221685 | Northlake Family Eyecare Pllc | Optometrist | 1500 Commons Circle Ste. 200, Northlake, TX 76226 | 2018-07-19 |
| 1518489640 | Juanita Gwen Lillard | Specialist/Technologist, Other | 7218 Crawford Road, Argyle, TX 76226 | 2017-07-11 |
| 1093244295 | Douglas Alan Kebodeaux | Dentist | 300 Fm 407 E, Suite #100, Argyle, TX 76226 | 2017-06-09 |
| 1306387188 | Chisholm Trail Urgent Care Pllc | Clinic/Center | 7214 Crawford Road, Suite 150, Argyle, TX 76226 | 2017-03-14 |
| Find all providers in zip 76226 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
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|---|---|---|---|---|
| 1720686496 | Hill Country Health Pllc | Family Medicine | 1010 Ranch Road 620 S Ste 107, Lakeway, TX 78734-5638 | 2020-10-14 |
| 1174139471 | Stacie Leann Herring | Family Medicine | 1300 Tx-107, La Villa, TX 78562 | 2020-09-22 |
| 1336753508 | Woodlands Diagnostic Clinic, Pa | Family Medicine | 9201 Pinecroft Dr Ste 200, Shenandoah, TX 77380-3889 | 2020-09-03 |
| 1932738465 | Arlington Integrative Medicine LLC | Family Medicine | 1420 N Cooper St Ste 109, Arlington, TX 76011-8530 | 2020-04-06 |
| 1396379772 | Heights Total Wellness Clinic, Pllc | Family Medicine | 1801 Durham Dr Ste 4, Houston, TX 77007-2272 | 2020-02-25 |
| 1063043271 | Katie Lianne Jubala | Family Medicine | 129 Park Place Cir, Iowa Park, TX 76367-1064 | 2020-01-28 |
| 1558909879 | Forrest Duane Giles | Family Medicine | 152 Mcvoid Rd, Springtown, TX 76082-5929 | 2019-12-17 |
| 1710525225 | Mary Osawe | Family Medicine | 1308 Winecup Ct, Allen, TX 75002-0983 | 2019-12-16 |
| 1609411735 | Sara E Bellard | Family Medicine | 4735 Ridgewood Ave, Port Arthur, TX 77642-6612 | 2019-11-13 |
| 1528600574 | Shearren Johnson | Family Medicine | 2162 Us Highway 259 S, Diana, TX 75640-3510 | 2019-10-10 |
| Find all providers with the same taxonomy | ||||
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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.