NPIMap

Organization Active NPI

South Texas PM & R Group, Inc.

  • Physical Medicine & Rehabilitation Physician
  • San Antonio, TX
National Provider Identifier
1104011329
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SOUTH TEXAS PM & R GROUP, INC.
Practice address
2 Spurs LN Ste 100
San Antonio, TX 78240-1760
Phone
(210) 615-2255
Fax
(210) 615-8432
NPI assigned
Sep 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Authorized official

Name
Dr. Alex Willingham, MDNPI 1558342634
Title
President
Phone
(210) 615-2225

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
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

2 Spurs LN Ste 100
San Antonio, TX 78240-1760

Mailing address

PO Box 380635
San Antonio, TX 78268-7635
Phone (210) 615-2225

Other identifiers 2

IdentifierTypeStateIssuer
112882902MedicaidTX
OOU54EOtherTXBLUE CROSS/BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051011000274 TX Part B Supplier - Clinic/Group Practice 8820013675 Receives reassigned benefits from 4 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

16023 Via Shavano
San Antonio, TX 78249
Phone (210) 615-2225

19126 Stonehue
San Antonio, TX 78258
Phone (210) 313-2509

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1104011329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 380635",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782687635",
            "telephone_number": "210-615-2225",
            "fax_number": "210-615-8432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SPURS LN STE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782401760",
            "telephone_number": "210-615-2255",
            "fax_number": "210-615-8432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TEXAS PM & R GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "WILLINGHAM",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-615-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112882902",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "OOU54E",
            "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 Sep 14, 2023; 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.

Verify at the official NPI Registry.