NPIMap

Organization Active NPI

Fredericksburg Family Clinic PA

Doing business as Cornerstone Clinic at Comfort

  • Family Medicine Physician
  • Comfort, TX
National Provider Identifier
1053464982
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FREDERICKSBURG FAMILY CLINIC PA
Doing business as
Cornerstone Clinic at Comfort
Practice address
815 Front St
Comfort, TX 78013
Phone
(830) 995-5633
NPI assigned
Jan 22, 2007
Last updated
Aug 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Cathy Donahy
Title
Office Manager
Phone
(830) 997-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

815 Front St
Comfort, TX 78013

Mailing address

514 W Windcrest St
Fredericksburg, TX 78624-4633
Phone (830) 997-0330

Other identifiers 4

IdentifierTypeStateIssuer
DG7779OtherTXMEDICARE RAILROAD
0009QHOtherTXBCBSTX
189877702OtherTXMEDICAID EPSDT
189877703MedicaidTX

Other names 1

  • Cornerstone Clinic at Comfort Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070216000138 TX Part B Supplier - Clinic/Group Practice 1254433550 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Comfort, TX; Fredericksburg, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1024393Fredericksburg Family Clinic PA815 Front Street, Comfort, TX 78013AccreditationMay 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Cornerstone Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1053464982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 W WINDCREST ST",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244633",
            "telephone_number": "830-997-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 FRONT ST",
            "city": "COMFORT",
            "state": "TX",
            "postal_code": "78013",
            "telephone_number": "830-995-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICKSBURG FAMILY CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "DONAHY",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "830-997-0330",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DG7779",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "0009QH",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID EPSDT",
            "identifier": "189877702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189877703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone Clinic at Comfort",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cornerstone Clinic at Comfort",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Comfort, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.