82 MEDICAL GROUP (NPI# 1851376248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1851376248 |
Entity Type | Organization |
Organization Name | 82 MEDICAL GROUP |
Practice Address |
149 Hart St Ste 1 Sheppard Afb TX 76311-3478 |
Practice Telephone | 9406763388 |
Enumeration Date | 2005-12-08 |
Last Update Date | 2010-11-19 |
Authorized Official Name | SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE) |
Authorized Official Telephone | 7035886419 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TX | NCPDP | 4510699 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073593570 | 82 Medical Group | Clinic/Center | 149 Hart St, Sheppard Afb, TX 76311-3477 | 2006-01-19 |
Street Address |
149 HART ST STE 1 |
City | SHEPPARD AFB |
State | TX |
Zip Code | 76311-3478 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336133123 | George Munkachy | Psychologist | 149 Hart St, 82nd Mdos/sgoh, Sheppard Afb, TX 76311-3477 | 2005-09-07 |
1861027476 | Taylor J Morgan | Pharmacist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2020-03-04 |
1538721196 | Jennifer Eileen Brown | Nurse Practitioner | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2019-07-03 |
1174094551 | Tiffany Machelle Esparza | Social Worker | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2018-12-11 |
1235641713 | Natalie Mounts | Pharmacist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2017-10-24 |
1730603978 | Kelly Lynn Hall | Physician Assistant | 149 Hart St, 82nd Mdos/sgop Family Practice, Sheppard Afb, TX 76354 | 2017-07-31 |
1588199129 | Julie Ojongofu | Pharmacist | 149 Hart St, 82 Mdg, Sheppard Afb, TX 76311-3430 | 2017-04-20 |
1437604469 | Marland Fox | Physician Assistant | 149 Hart St, Bldg 1200, Sheppard Afb, TX 76311-3430 | 2016-08-19 |
1386019669 | Matthew Robertson | Physical Therapist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2015-12-11 |
1265818512 | Helena Guerra | Nurse Practitioner | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2015-08-09 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740792076 | Hunter Tristan Justice Ferguson | Military Health Care Provider | 527 I Ave Unit 72, Sheppard Afb, TX 76311 | 2017-10-26 |
1588083356 | Keenan David Atwood | Emergency Medicine | 145 Hart St, Aerospace Medicine Clinic, Sheppard Afb, TX 76311 | 2014-04-09 |
1649525338 | Austin Douglas Solomons | Social Worker | 82 Medical Group, 149 Hart Street, Sheppard Afb, TX 76311 | 2012-07-18 |
1700162831 | Kristina Marie Zuccarelli | Student in an Organized Health Care Education/Training Program | 132 Hart Street, Sheppard Afb, TX 76311 | 2011-11-03 |
1679859367 | Brandon William Keyser | Dentist | 82 Dental Squadron/sgd, 149 Hart St Ste 4, Sheppard Afb, TX 76311 | 2011-10-26 |
1437456373 | Jennifer Leigh Noblin | Military Health Care Provider | Sheppard Afb Mental Health Clinic, 149 Hart St. Bldg 1200, Wichita Falls, TX 76311 | 2011-02-11 |
1336450444 | Allen Chan | Dentist | 82nd Medical Group (aetc) Pas: Sq0jfb5d, Sheppard Afb, Apo, AA 76311 | 2010-06-24 |
1003140344 | Christopher Shawn Couch | Military Health Care Provider | 718 I Ave 82 Mss/dpf, Bldg 1900 Dept Xufb, Sheppard Afb, TX 76311 | 2009-09-18 |
1124255583 | Danny Lee Dennis Jr. | Military Health Care Provider | 939 Missile Road Bld 1900, Wichita Falls, TX 76311 | 2009-06-12 |
1902008980 | Jason West Cromar | Military Hospital | 149 G W Hart St., Bldg. 1200, 82 Mdg/sgp, Sheppard Afb, TX 76311 | 2007-06-01 |
Find all providers in zip 76311 |
Taxonomy Code | 261QM1100X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Military/U.S. Coast Guard Outpatient |
The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326527177 | William Beaumont Army Medical Center | Clinic/Center | 11291 Sgt E Churchill St, Fort Bliss, TX 79918-8001 | 2018-08-13 |
1124505359 | Carl R Darnall Army Medical Center | Clinic/Center | 5200 Bunny Trail, Killeen, TX 76549 | 2018-07-20 |
1568948933 | Carl R Darnall Army Medical Center | Clinic/Center | 415 31st and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
1740766112 | Carl R Darnall Army Medical Center | Clinic/Center | Bldg 2255 52nd and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
1396119681 | Brooke Army Medical Center | Clinic/Center | 2407 N New Braunfels, Bldg 147, Ft Sam Houston, TX 78234 | 2015-11-24 |
1932595204 | Carl R Darnall Army Medical Center | Clinic/Center | 9410 19th St, Fort Hood, TX 76544 | 2015-04-13 |
1154717650 | Carl R Darnall Army Medical Center | Clinic/Center | 31002 74th Street, Fort Hood, TX 76544 | 2015-04-10 |
1073909578 | Carl R Darnall Army Medical Center | Clinic/Center | 37016 77th Street, Fort Hood, TX 76544 | 2015-04-10 |
1972999472 | Carl R Darnall Army Medical Center | Clinic/Center | 24001 Battalion Ave, 58th and 62nd Streets, Fort Hood, TX 76544 | 2015-04-10 |
1619365285 | Brooke Army Medical Center | Clinic/Center | 10010 Rogers Run, Suite 100, San Antonio, TX 78251-4403 | 2015-01-05 |
Find all providers with the same taxonomy |
City | SHEPPARD AFB |
Zip Code | 76311 |
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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.