NPIMap

Individual provider Active NPI

Suja Maria Sabastin, M.D.

  • Family Medicine Physician
  • Georgetown, TX
National Provider Identifier
1073703773
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
T1833 Issued in TX
Practice address
1507 Rivery Blvd
Georgetown, TX 78628-3058
Phone
(512) 509-9550
Fax
(512) 509-9555
NPI assigned
Jul 29, 2007
Last updated
Sep 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 260968 NY
Family Medicine Physician 207Q00000X T1833 TX Primary

Addresses

Primary practice location

1507 Rivery Blvd
Georgetown, TX 78628-3058

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssabastin852817@direct.sw.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110624000218 NY Practitioner - Family Practice 3870785512 Reassigns benefits to 2 organizations
I20210608002882 TX Practitioner - Family Practice 3870785512 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

1507 Rivery Blvd
Georgetown, TX 78628-3058
Phone (512) 509-9550

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

7451 W State Hwy 29
Baylor Scott and White Clinic Georg
Georgetown, TX 78628-6849
Phone (512) 509-8700

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Family Medicine CurrentSince Jun 9, 2021 Accepting new patients
Morris Heights Health Center, Inc. CurrentSince Jul 22, 2017 Accepting new patients
Morris Heights Health Center, Inc. CurrentSince Jul 22, 2017 Accepting new patients
Scott & White Clinic Family Medicine Current Accepting new patients
Scott and White Clinic Family Medicine CurrentSince Jun 9, 2021 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

25 E 183rd St
Bronx, NY 10453
Phone (718) 483-1270

85 W Burnside Ave
Bronx, NY 10453
Phone (718) 483-1270

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

1507 Rivery Blvd
Georgetown, TX 78628
Phone (512) 509-9550

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

2401 S 31st St
#200
Temple, TX 76508
Phone (254) 215-0100

Interoperability endpoints

  • Direct secure messaging: ssabastin852817@direct.sw.org
  • Direct secure messaging: ssabastin840102@nychhc.direct-ci.com

Organizations & group practices 7

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 6

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": "1185667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1073703773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 RIVERY BLVD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283058",
            "telephone_number": "512-509-9550",
            "fax_number": "512-509-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SABASTIN",
        "first_name": "SUJA",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-29",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "260968",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T1833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssabastin852817@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1507 Rivery Blvd",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786283058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.