Active NPI
Robert Marriott Medical Corp
- Surgery Physician
- Beaumont, TX
National Provider Identifier
1073064689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- ROBERT MARRIOTT MEDICAL CORP
- Practice address
- 1175 Denton St
Beaumont, TX 77707-3913 - Phone
- (877) 878-3289
- Fax
- (877) 817-3227
- NPI assigned
- Oct 18, 2016
- Last updated
- Nov 8, 2018
- Organization subpart
- Yes
- Parent organization
- ADVANTAGE WOUND CARE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert J Marriott, MD
- Title
- Ceo
- Phone
- (877) 878-3289
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | NU | Primary |
Addresses
Primary practice location
1175 Denton St
Beaumont, TX 77707-3913
Mailing address
222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 878-3289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3320855-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, NY, ME
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090518000379 | TX | Part B Supplier - Clinic/Group Practice | 2567531494 |
Receives reassigned benefits from 47 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20110623000129 | NY | Part B Supplier - Clinic/Group Practice | 2567531494 |
Receives reassigned benefits from 8 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brentwood, NY; Bronx, NY; Great Neck, NY; Kings Park, NY; Mamaroneck, NY; New York, NY; Staten Island, NY |
| O20130104000175 | ME | Part B Supplier - Clinic/Group Practice | 2567531494 |
Receives reassigned benefits from 11 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Yarmouth, ME; Waterville, ME; South Portland, ME; South Paris, ME; Sanford, ME; Saco, ME; Lewiston, ME; Portland, ME… |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Advantage Wound Care
- Surgery Physician
- El Segundo, CA
- NPI 1083883938
O20090518000379, O20110623000129, O20130104000175
National Provider Directory
National Provider Directory- Part of
- Parmount Meadows
Practitioners & affiliated clinicians
Practitioners 7
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.
-
- Surgery Physician
- El Segundo, CA
- NPI 1700804887
-
- Family Nurse Practitioner
- Zavalla, TX
- NPI 1023536174
-
- Family Nurse Practitioner
- San Antonio, TX
- NPI 1033710991
-
- Surgery Physician
- Arlington, TX
- NPI 1033115274
-
- Family Nurse Practitioner
- Lafayette, LA
- NPI 1821487380
-
- Nurse Practitioner
- Little Rock, AR
- NPI 1417455361
-
- Surgery Physician
- Augusta, GA
- NPI 1124040266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1541635200000",
"number": "1073064689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N PACIFIC COAST HWY STE 2175",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455639",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1175 DENTON ST",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777073913",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROBERT MARRIOTT MEDICAL CORP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ADVANTAGE WOUND CARE",
"enumeration_date": "2016-10-18",
"last_updated": "2018-11-08",
"status": "A",
"authorized_official_last_name": "MARRIOTT",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "877-878-3289",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3320855-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.