| Hcc Of Fairfield Llc | |
|
125 Newman St Fairfield TX 75840-1419 | |
| (866) 931-8882 | |
| Not Available |
| Full Name | Hcc Of Fairfield Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 125 Newman St, Fairfield, Texas |
| Authorized Official Name and Position | Ron Weiss (PRESIDENT) |
| Authorized Official Contact | 8669318882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hcc Of Fairfield Llc 17304 Preston Rd Ste 1400 Dallas TX 75252-5633 Ph: (866) 931-8882 | Hcc Of Fairfield Llc 125 Newman St Fairfield TX 75840-1419 Ph: (866) 931-8882 |
| NPI Number | 1487122750 |
|---|---|
| Provider Enumeration Date | 11/05/2018 |
| Last Update Date | 10/10/2019 |
| Medicare PECOS PAC ID | 3072859099 |
|---|---|
| Medicare Enrollment ID | O20190114000163 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487122750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Frank J Fasullo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205812625 PECOS PAC ID: 5991618084 Enrollment ID: I20040107000761 |
| Provider Name | Mark Lekas |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700827474 PECOS PAC ID: 6800798513 Enrollment ID: I20040123000099 |
| Provider Name | Perry E Bassett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245233857 PECOS PAC ID: 2163325002 Enrollment ID: I20040129000143 |
| Provider Name | Guido R Toscano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215008487 PECOS PAC ID: 8325931215 Enrollment ID: I20040204000899 |
| Provider Name | Peter Way |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689603714 PECOS PAC ID: 3678462363 Enrollment ID: I20040311000868 |
| Provider Name | Joseph R Berger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508859596 PECOS PAC ID: 5395730527 Enrollment ID: I20040417000212 |
| Provider Name | Agbolade Olusoga Odutayo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316992779 PECOS PAC ID: 6709873680 Enrollment ID: I20040430000923 |
| Provider Name | Paul J Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710075239 PECOS PAC ID: 4385634161 Enrollment ID: I20040513001389 |
| Provider Name | Ronald D Tanner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568441616 PECOS PAC ID: 0749270536 Enrollment ID: I20040513001402 |
| Provider Name | Ramon Cantu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023049863 PECOS PAC ID: 0446241715 Enrollment ID: I20040524001304 |
| Provider Name | William C Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619945060 PECOS PAC ID: 6406831759 Enrollment ID: I20040621001412 |
| Provider Name | Felix M Ekanem |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467494708 PECOS PAC ID: 4284624271 Enrollment ID: I20040708001234 |
| Provider Name | Eduardo M Wilkinson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1477662260 PECOS PAC ID: 1153309539 Enrollment ID: I20040712000984 |
| Provider Name | Ryan Ford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376523951 PECOS PAC ID: 1951381243 Enrollment ID: I20040726000968 |
| Provider Name | Francisco Gonzalez Rosales |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548268915 PECOS PAC ID: 0042281230 Enrollment ID: I20040803000307 |
| Provider Name | Jonathan S Coolidge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215917430 PECOS PAC ID: 1658342621 Enrollment ID: I20040803001412 |
| Provider Name | Salomon D Kramer |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1912114091 PECOS PAC ID: 5890763833 Enrollment ID: I20040922000729 |
| Provider Name | Mark Bruce |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669416871 PECOS PAC ID: 2567423932 Enrollment ID: I20041020000497 |
| Provider Name | Jyothi N Achi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023029287 PECOS PAC ID: 4688635881 Enrollment ID: I20041021000268 |
| Provider Name | Harold A Heafer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1750364329 PECOS PAC ID: 3274596929 Enrollment ID: I20041104000615 |
| Provider Name | Wasim A Sheikh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407883788 PECOS PAC ID: 9032173950 Enrollment ID: I20041118001233 |
| Provider Name | Ryan D Cradeur |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326027897 PECOS PAC ID: 6608834031 Enrollment ID: I20041230000586 |
| Provider Name | Glenn C Armen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740236140 PECOS PAC ID: 0941268379 Enrollment ID: I20041230000610 |
| Provider Name | Christen J Leblanc |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1447206669 PECOS PAC ID: 9739120429 Enrollment ID: I20050512000458 |
| Provider Name | Mark R Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003877077 PECOS PAC ID: 5991740599 Enrollment ID: I20050623000912 |
| Provider Name | James S Jones |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821140906 PECOS PAC ID: 6608892815 Enrollment ID: I20051018000214 |
| Provider Name | James Loughran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588643753 PECOS PAC ID: 3476573247 Enrollment ID: I20060220000550 |
| Provider Name | Christopher W Bristow |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487672861 PECOS PAC ID: 5193721421 Enrollment ID: I20061010000639 |
| Provider Name | David A Latham |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992986368 PECOS PAC ID: 0840361754 Enrollment ID: I20080620000291 |
| Provider Name | John S Yatsu |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1922158799 PECOS PAC ID: 7214070028 Enrollment ID: I20100202000591 |
| Provider Name | Annette M Elbert |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1205850856 PECOS PAC ID: 5991799389 Enrollment ID: I20100204000143 |
| Provider Name | James E Mccrary |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811108731 PECOS PAC ID: 1557493855 Enrollment ID: I20100722000486 |
| Provider Name | Patrick C Obasi |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326267147 PECOS PAC ID: 7416073457 Enrollment ID: I20100927001130 |
| Provider Name | Ratchnee France |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225030042 PECOS PAC ID: 3678599503 Enrollment ID: I20101028001000 |
| Provider Name | Christian Moya |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1417260845 PECOS PAC ID: 1153516059 Enrollment ID: I20101117000107 |
| Provider Name | Donatus M Egbonim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962440875 PECOS PAC ID: 7719931476 Enrollment ID: I20111229000781 |
| Provider Name | Farrukh Badsha |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013100973 PECOS PAC ID: 7810177110 Enrollment ID: I20120125000534 |
| Provider Name | William Easton Walker |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1619242047 PECOS PAC ID: 8921264169 Enrollment ID: I20120716000560 |
| Provider Name | Carl James Kissling |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699754846 PECOS PAC ID: 3971491630 Enrollment ID: I20130828000010 |
| Provider Name | Saad A Abdullah |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407089154 PECOS PAC ID: 1254586522 Enrollment ID: I20130828000400 |
| Provider Name | Jerry A Allison |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891753232 PECOS PAC ID: 3678501756 Enrollment ID: I20130829000836 |
| Provider Name | Israel T Haile |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922328335 PECOS PAC ID: 6901033802 Enrollment ID: I20131223000860 |
| Provider Name | Jonathan P Pesco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447570098 PECOS PAC ID: 2860627460 Enrollment ID: I20140303000602 |
| Provider Name | Emad Shoukry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053318857 PECOS PAC ID: 1759353337 Enrollment ID: I20141231001191 |
| Provider Name | Md Saifur Rashid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497002778 PECOS PAC ID: 5597081638 Enrollment ID: I20150306001784 |
| Provider Name | David Andrew Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710233846 PECOS PAC ID: 7719202126 Enrollment ID: I20151023000382 |
| Provider Name | Matthew C Altman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528491305 PECOS PAC ID: 8729387121 Enrollment ID: I20160526000763 |
| Provider Name | Michael Corpus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902005234 PECOS PAC ID: 1658437041 Enrollment ID: I20160930000239 |
| Provider Name | Roberta L Vickery |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1619297348 PECOS PAC ID: 0446376552 Enrollment ID: I20171017001295 |
| Provider Name | Jacob Kent Barney |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568810190 PECOS PAC ID: 5597046912 Enrollment ID: I20171211000612 |
| Provider Name | Herman Laroy Toliver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841481041 PECOS PAC ID: 3971756271 Enrollment ID: I20180208002735 |
| Provider Name | Bilal H Piracha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083920888 PECOS PAC ID: 6901040872 Enrollment ID: I20180509002080 |
| Provider Name | Shery Malaty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114314119 PECOS PAC ID: 5092029355 Enrollment ID: I20180822001696 |
| Provider Name | Tonya N Basque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316423452 PECOS PAC ID: 5496038093 Enrollment ID: I20180925000147 |
| Provider Name | Adetomiwa I Ogundere |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003227745 PECOS PAC ID: 1254628647 Enrollment ID: I20181005000952 |
| Provider Name | Karel Capek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851529622 PECOS PAC ID: 5294073532 Enrollment ID: I20190213000355 |
| Provider Name | Jared Criswell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265896146 PECOS PAC ID: 9133454101 Enrollment ID: I20190712001407 |
| Provider Name | Nelson A Garay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154795284 PECOS PAC ID: 7810283520 Enrollment ID: I20190806000505 |
| Provider Name | Adi Shemesh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164885471 PECOS PAC ID: 4082904198 Enrollment ID: I20191127000317 |
| Provider Name | Mercy A Fultang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821593039 PECOS PAC ID: 8921342965 Enrollment ID: I20200115000395 |
| Provider Name | Dana J Bullock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114422078 PECOS PAC ID: 0345678199 Enrollment ID: I20200310002246 |
| Provider Name | Adaobi C Nnaji |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174985618 PECOS PAC ID: 9335487875 Enrollment ID: I20200429000473 |
| Provider Name | Daniel L Mcmahan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992368146 PECOS PAC ID: 1951718766 Enrollment ID: I20210323001822 |
| Provider Name | Hamza Muhammad Tola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154818342 PECOS PAC ID: 6406259373 Enrollment ID: I20210729002252 |
| Provider Name | Samuel B Grimmer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669977617 PECOS PAC ID: 1850649658 Enrollment ID: I20210922002457 |
| Provider Name | Omar Qazi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770991754 PECOS PAC ID: 7719281310 Enrollment ID: I20220216002030 |
| Provider Name | Nethuja Salagundla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508240722 PECOS PAC ID: 6103124508 Enrollment ID: I20220722002782 |
| Provider Name | Jasleen Kaur Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932767910 PECOS PAC ID: 8426385147 Enrollment ID: I20220816003910 |
| Provider Name | Vivek Bhupathi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780172775 PECOS PAC ID: 2860895216 Enrollment ID: I20230228001365 |
| Provider Name | Seyed Mohammad Mehdi Khalafi |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1265896393 PECOS PAC ID: 9537520531 Enrollment ID: I20230807000722 |
| Provider Name | Shisto Rais |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255960449 PECOS PAC ID: 4880056043 Enrollment ID: I20230821000583 |
| Provider Name | Frederick Allen Thurmond |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1598761777 PECOS PAC ID: 9436120102 Enrollment ID: I20240318003812 |
Freestone Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 734 W Commerce St, Suite C, Fairfield, TX 75840 Phone: 903-389-2121 Fax: 903-389-1601 |