Ocean Blue Holdings, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

OCEAN BLUE HOLDINGS, LLC

Practice address

12333 Bear PLZ Ste 100
Burleson, TX 76028-0284

Phone

(817) 789-4099

Fax

(800) 616-4641

NPI assigned

Aug 28, 2018

Organization subpart

No

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

Authorized official

Name

Renukaben Patel

Title

Officer

Phone

(856) 873-3826

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 2

• TEXAS HEALTH RX PHARMACY Doing business as
• Johnson Pharmacy Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Johnson Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ocean Blue Holdings, LLC

  • Long Term Care Pharmacy
  • Burleson, TX
  • NPI 1881208288
  NPD tax ID

Practitioners 4

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

• Raj Mehta, PHARMD

  • Pharmacist
  • Burleson, TX
  • NPI 1164392429
  NPD
• Kirat Shahiwala, PHARM.D., BSPHARM

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Burleson, TX
  • NPI 1275900128
  NPD
• Hardik Chandrakant Patel, LICENSED PHARMACIST

  • Community/Retail Pharmacy
  • Burleson, TX
  • NPI 1407445018
  NPD (past)
• Neha Patel

  • Pharmacist
  • Dallas, TX
  • NPI 1720484314
  NPD (past)

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1104307065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12333 BEAR PLZ STE 100",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760280284",
            "telephone_number": "817-789-4099",
            "fax_number": "800-616-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12333 BEAR PLZ STE 100",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760280284",
            "telephone_number": "817-789-4099",
            "fax_number": "800-616-4641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 NE Johnson Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Burleson",
            "state": "TX",
            "postal_code": "760284139",
            "country_code": "US",
            "telephone_number": "817-789-4099",
            "fax_number": "800-616-4641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCEAN BLUE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RENUKABEN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "856-873-3826"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150249",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TEXAS HEALTH RX PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• All providers in Burleson, TX
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.