Individual provider Active NPI

Bravein Amalakuhan, M.D.

  • Pulmonary Disease Physician
  • San Antonio, TX
National Provider Identifier
1053623512
Registry record updated May 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
R1338 Issued in TX
Practice address
4458 Medical Dr Ste 505
San Antonio, TX 78229-3748
Phone
(210) 690-7400
Fax
(210) 690-7405
NPI assigned
Jul 12, 2010
Last updated
May 31, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT198120 PA
Internal Medicine Physician 207R00000X R1338 TX
Critical Care Medicine (Internal Medicine) Physician 207RC0200X R1338 TX
Pulmonary Disease Physician 207RP1001X R1338 TX Primary

Addresses

Primary practice location

4458 Medical Dr Ste 505
San Antonio, TX 78229-3748

Mailing address

4458 Medical Dr Ste 505
San Antonio, TX 78229-3748
Phone (210) 690-7400

Other identifiers 1

IdentifierTypeStateIssuer
368256901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170206000340 TX Practitioner - Pulmonary Disease 3072755578 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Ips LLCGroup PAC ID 9638356801, 44 clinicians

Practice addresses (Care Compare)

1434 E Sonterra Blvd
Suite 210
San Antonio, TX 78258-4973
Phone (210) 690-7400

4458 Medical Dr
Suite 505
San Antonio, TX 78229-3748
Phone (210) 690-7400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.39 of 100Reported as individual
Quality
79.43
Improvement activities
0
Cost
75.12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT198120PAMDInternal Medicine Physician
R1338TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Ips LLC Critical Care Medicine CurrentSince Jan 20, 2017 Accepting new patients

Locations

34910 Interstate 10 W
Ste 601
Boerne, TX 78006
Phone (830) 248-1207

1434 E Sonterra Blvd
Ste 210
San Antonio, TX 78258
Phone (210) 481-3119

21 Spurs Ln
Ste 230B
San Antonio, TX 78240

4458 Medical Dr
Ste 505
San Antonio, TX 78229

4499 Medical Dr
#150
San Antonio, TX 78229
Phone (210) 614-8181

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1053623512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4458 MEDICAL DR STE 505",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293748",
            "telephone_number": "210-690-7400",
            "fax_number": "210-690-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4458 MEDICAL DR STE 505",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293748",
            "telephone_number": "210-690-7400",
            "fax_number": "210-690-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMALAKUHAN",
        "first_name": "BRAVEIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-12",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT198120",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "R1338",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "R1338",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "R1338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "368256901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.