Brent Lee Mainwaring, M.D.
Individual provider Active NPI Specialist · Beaumont, TX
NPI 1023050341 · NPPES record last updated Jul 14, 2011
Key facts
- NPI
- 1023050341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- H7781 (TX)
- Practice address
- 3405 College St
Beaumont, TX 77701-4613 - Phone
- (409) 832-2211
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Medical University of South Carolina College of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Winnie Community Hospital LLC
Practice addresses (Care Compare)
3405 College St
Beaumont, TX 77701-4613
Phone 4092321500217
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041217000107 | TX | Practitioner - Diagnostic Radiology | 8022074434 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H7781 | TX | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winnie Community Hospital, L.L.C. | Current |
Accepting new patients | |
| Winnie Community Hospital LLC | Current | Accepting new patients | |
| Winnie Community Hospital, L.L.C. | Current |
Accepting new patients |
Locations
3405 College St
Beaumont, TX 77701
Phone (409) 832-2211
3445 Regional Dr
#R
Port Arthur, TX 77642
Phone (409) 962-2299
538 Broadway
Winnie, TX 77665
Phone (409) 296-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | H7781 | TX | Yes |
Addresses
Primary practice location
3405 College St
Beaumont, TX 77701-4613
Mailing address
1129 Moore Rd
Beaumont, TX 77713-3918
Phone (409) 656-6951
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00TF2E | Other | TX | BC/BS |
| 136949801 | Medicaid | TX |
NPI Registry JSON
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310601600000",
"number": "1023050341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1129 MOORE RD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777133918",
"telephone_number": "409-656-6951",
"fax_number": "409-753-3873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3405 COLLEGE ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777014613",
"telephone_number": "409-832-2211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAINWARING",
"first_name": "BRENT",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2011-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "H7781",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "00TF2E",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136949801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.