NPIMap

Organization Active NPI

Gastroenterology Clinic of San Antonio, P.a.

  • Gastroenterology Physician
  • San Antonio, TX
National Provider Identifier
1053490631
Registry record updated Oct 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGY CLINIC OF SAN ANTONIO, P.A.
Practice address
8550 Datapoint Dr
Suite 200
San Antonio, TX 78229-3270
Phone
(210) 615-8308
Fax
(210) 615-8313
NPI assigned
Nov 3, 2006
Last updated
Oct 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2015

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

Authorized official

Name
Russell Havranek, MDNPI 1871672519
Title
Ceo
Phone
(210) 615-8308

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X Primary

Addresses

Primary practice location

8550 Datapoint Dr
Suite 200
San Antonio, TX 78229-3270

Mailing address

8550 Datapoint Dr
Suite 200
San Antonio, TX 78229-3270
Phone (210) 615-8308

Other identifiers 2

IdentifierTypeStateIssuer
044080201MedicaidTX
00BL45OtherTXMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000804 TX Part B Supplier - Clinic/Group Practice 7618881681 Receives reassigned benefits from 13 practitioners
Practice locations: San Antonio, TX

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
45D0710307Gastroenterology Clinic of San Antonio8550 Datapoint Suite 240, San Antonio, TX 78229AccreditationJul 30, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

8550 Datapoint Dr
San Antonio, TX 78229
Phone (210) 615-8308

8550 Datapoint Dr
Ste 200
San Antonio, TX 78229
Phone (210) 615-8308

8550 Datapoint Dr
Ste LL100
San Antonio, TX 78229
Phone (210) 615-8308

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDBEAD

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446076800000",
    "number": "1053490631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8550 DATAPOINT DR",
            "address_2": "SUITE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293270",
            "telephone_number": "210-615-8308",
            "fax_number": "210-615-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8550 DATAPOINT DR",
            "address_2": "SUITE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293270",
            "telephone_number": "210-615-8308",
            "fax_number": "210-615-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY CLINIC OF SAN ANTONIO, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2015-10-29",
        "status": "A",
        "authorized_official_last_name": "HAVRANEK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-615-8308",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044080201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00BL45",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; 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.