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ENDOVASCULAR LAB PLLC
NPI 1407482003
Surgery - Vascular Surgery in Odessa, TX

Active since March 16, 2020
612 N WASHINGTON AVENUE, SUITE 100, ODESSA, TX 79761(432) 770-7211 Get Directions Write a Review

NPPES record last updated: August 14, 2020. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Aug 14, 2020, Mar 16, 2020 (2 updates tracked since 2020).

About Endovascular Lab Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ENDOVASCULAR LAB PLLC (NPI 1407482003) is a healthcare organization registered as a vascular surgery in Odessa, Texas and active in the NPI registry since March 2020. The organization lists James Y Li, President, as its authorized official.

NPPES Registry Identity

NPI1407482003
Entity TypeOrganization
Primary Taxonomy2086S0129X
Legal Business NameENDOVASCULAR LAB PLLC
Location Address612 N WASHINGTON AVENUE, SUITE 100Odessa, TX 79761
Mailing Address612 N Washington AvenueOdessa, TX 79761 · (432) 770-7211
Phone(432) 770-7211
Organization SubpartNo
Authorized OfficialJames Y LiPresident · (432) 770-7211
Enumeration DateMarch 16, 2020
Last NPPES UpdateAugust 14, 20202 updates tracked since enumeration
NPPES CertifiedAugust 14, 2020
✔ NPI 1407482003 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
612 N WASHINGTON AVENUE, Odessa, TX 79761
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Endovascular Lab Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Endovascular Lab PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Daniela Flores, DNP, FNP-C
Nurse Practitioner
NPI 1255044947
612 N WASHINGTON AVE STE 200
Odessa, TX 79761
(432) 332-9263
✔ PECOS✔ Accepts MedicareSame address
James Li, MD
Vascular Surgery
NPI 1932184629
612 N WASHINGTON AVE STE 200
Odessa, TX 79761
(432) 332-9263
✔ PECOS✔ Accepts MedicareSame address
Kelly Mattimoe, FNP
Nurse Practitioner
NPI 1235867623
612 N WASHINGTON AVE STE 200
Odessa, TX 79761
(432) 332-9263
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Endovascular Lab PLLC's NPI number?

The NPI number for Endovascular Lab PLLC is 1407482003. It was assigned to this organization in the NPPES registry on March 16, 2020.

Where is Endovascular Lab PLLC located?

Endovascular Lab PLLC is located at 612 N Washington Avenue Suite 100, Odessa, TX 79761. The listed phone number is (432) 770-7211.

What is Endovascular Lab PLLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

Is Endovascular Lab PLLC enrolled in Medicare?

Yes. Endovascular Lab PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Endovascular Lab PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Endovascular Lab PLLC, in Nurse Practitioner and Vascular Surgery. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Endovascular Lab PLLC accept?

Health plans from Blue Cross and Blue Shield of Texas list Endovascular Lab PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Endovascular Lab PLLC was last updated on August 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.