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COUNTRY CLUB MEDICAL CENTER LLC
NPI 1508269523
Internal Medicine in El Paso, TX

Active since October 04, 2014
8041 N MESA ST, SUITE B-2, EL PASO, TX 79932(915) 474-2454(915) 222-8895 Get Directions Write a Review

NPPES record last updated: December 12, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Country Club Medical Center Llc NPPES

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

COUNTRY CLUB MEDICAL CENTER LLC (NPI 1508269523) is a healthcare organization registered as an internal medicine in El Paso, Texas and active in the NPI registry since October 2014. The organization lists Tracy Edward Short, Owner, as its authorized official.

NPPES Registry Identity

NPI1508269523
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCOUNTRY CLUB MEDICAL CENTER LLC
Location Address8041 N MESA ST, SUITE B-2El Paso, TX 79932-1735
Mailing Address8041 N Mesa St, Suite B-2El Paso, TX 79932-1735 · (915) 474-2454 · Fax (915) 222-8895
Phone(915) 474-2454
Fax(915) 222-8895
Organization SubpartNo
Authorized OfficialTracy Edward ShortOwner · (915) 474-2454
Enumeration DateOctober 4, 2014
Last NPPES UpdateDecember 12, 2014
✔ NPI 1508269523 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in TX · J0549
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
8041 N MESA ST, El Paso, TX 79932
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Other Identifiers 9

Medicare PIN8G5077TX
Medicare UPINQ53376TX
Other8A3569TX · Medicare Id - Type Unspecified
Medicare UPINP80362TX
Medicaid218658701TX
Medicaid40379761NM
Medicare PINTXB106104TX
Medicaid00825875NM
Medicare UPINE18877TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Country Club Medical Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Country Club Medical Center LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Wilbur Strader, M.D.
Internal Medicine
NPI 1740283043
1201 E SCHUSTER AVE BLDG 7
El Paso, TX 79902
(915) 533-5486
✔ PECOS6.8 mi
Gary Kavonian, MD
Internal Medicine
NPI 1558321331
10301 GATEWAY BLVD W
El Paso, TX 79925
(915) 595-9000
✔ PECOS✔ Accepts Medicare15 mi

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 Country Club Medical Center LLC's NPI number?

The NPI number for Country Club Medical Center LLC is 1508269523. It was assigned to this organization in the NPPES registry on October 4, 2014.

Where is Country Club Medical Center LLC located?

Country Club Medical Center LLC is located at 8041 N Mesa St Suite B-2, El Paso, TX 79932. The listed phone number is (915) 474-2454.

What is Country Club Medical Center LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Country Club Medical Center LLC enrolled in Medicare?

Yes. Country Club Medical Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Country Club Medical Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Internal Medicine, reassign their Medicare billing to Country Club Medical Center LLC. 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, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Country Club Medical Center LLC was last updated on December 12, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.