NPIMap

Organization Active NPI

Plastic, Reconstructive & Microsurgical Associates of South Texas PLLC

  • Plastic and Reconstructive Surgery Physician
  • San Antonio, TX
National Provider Identifier
1063405504
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
PLASTIC, RECONSTRUCTIVE & MICROSURGICAL ASSOCIATES OF SOUTH TEXAS PLLC
Practice address
9635 Huebner Rd
San Antonio, TX 78240-1512
Phone
(210) 692-1181
Fax
(210) 692-7584
NPI assigned
Aug 30, 2005
Last updated
Feb 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Peter Robert Ledoux, MDNPI 1639171770
Title
President
Phone
(210) 692-1181

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
Plastic and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

9635 Huebner Rd
San Antonio, TX 78240-1512

Mailing address

9635 Huebner Rd
San Antonio, TX 78240-1512
Phone (210) 692-1181

Other practice location 1

502 Madison Oak Dr Ste 220
San Antonio, TX 78258-4192
Phone (210) 692-1181

Other identifiers 1

IdentifierTypeStateIssuer
084224701MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041111000380 TX Part B Supplier - Clinic/Group Practice 9436112232 Receives reassigned benefits from 41 practitioners
Practice locations: San Antonio, TX; Plano, TX; Houston, TX; Frisco, TX; McKinney, 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
45D2056051Plastic Reconstructive & Microsurgical Associates9635 Huebner Road, San Antonio, TX 78240Certificate of waiverMar 20, 2027

National Provider Directory

National Provider Directory

Locations

5575 Frisco Square Blvd
Ste 110
Frisco, TX 75034
Phone (972) 238-0512

9230 Katy Fwy
Ste 425
Houston, TX 77055

4499 Medical Dr
Ste 311
San Antonio, TX 78229
Phone (210) 615-8757

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1063405504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9635 HUEBNER RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782401512",
            "telephone_number": "210-692-1181",
            "fax_number": "210-692-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9635 HUEBNER RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782401512",
            "telephone_number": "210-692-1181",
            "fax_number": "210-692-7584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "502 Madison Oak Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782584192",
            "country_code": "US",
            "telephone_number": "210-692-1181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PLASTIC, RECONSTRUCTIVE & MICROSURGICAL ASSOCIATES OF SOUTH TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "LEDOUX",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-692-1181",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084224701",
            "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 Feb 22, 2023; 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.