Bastrop Medical Clinic, PA
Organization Active NPI Internal Medicine Physician · Bastrop, TX
NPI 1043236201 · NPPES record last updated Jul 16, 2026
Key facts
- NPI
- 1043236201
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- BASTROP MEDICAL CLINIC, PA
- Practice address
- 195 S Hasler Blvd
Suite B-1
Bastrop, TX 78602-4081 - Phone
- (512) 308-1555
- Fax
- (512) 308-1565
- NPI assigned
- Jul 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Augustin Roger Batlle
- Title
- Owner
- Phone
- (512) 308-1555
Practitioners 3
-
Katie Jo Dixon, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1052389 | Bastrop Medical Clinic | Certificate of waiver | Feb 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140107000145 | TX | Part B Supplier - Clinic/Group Practice | 8628074705 |
Receives reassigned benefits from 3 practitioners Practice locations: Bastrop, TX |
National Provider Directory
Locations
195 S Hasler Blvd
Ste B1
Bastrop, TX 78602
Phone (512) 308-1555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X | J6324 | TX |
Addresses
Primary practice location
195 S Hasler Blvd
Suite B-1
Bastrop, TX 78602-4081
Mailing address
PO Box 938
Killeen, TX 76540-0938
Phone (512) 308-1555
Other providers in Bastrop, TX
- Bastrop Family Dentistry
- Bastrop Family Eye Care
- Bastrop Independent School District
- Bastrop Kids Teeth, PLLC
- Bastrop Lost Pines Center for Cancer Care LTD
- Bastrop Medicine Shop LLC
- Bastrop Modern Dentistry,PC
- Bastrop Open MRI L L P Partnership
- Augustin Roger Batlle
- Lance A Beahm
All providers in Bastrop, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2026. 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.
- 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.