NPIMap

Organization Active NPI

The Austin Diagnostic Clinic, PLLC

  • Cardiovascular Disease Physician
  • Austin, TX
National Provider Identifier
1104803816
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
THE AUSTIN DIAGNOSTIC CLINIC, PLLC
Practice address
12221 Mo Pac Expwy North
Dept of Cardiology
Austin, TX 78758
Phone
(512) 901-4001
Fax
(512) 901-3901
NPI assigned
Dec 23, 2005
Last updated
Jun 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
John Rebok
Title
Vice President
Phone
(615) 372-5004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

12221 Mo Pac Expwy North
Dept of Cardiology
Austin, TX 78758

Mailing address

2000 Health Park Dr Dept of
Brentwood, TN 37027-4525
Phone (615) 372-5004

Other identifiers 1

IdentifierTypeStateIssuer
140347904MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000236 TX Part B Supplier - Clinic/Group Practice 1254244551 Receives reassigned benefits from 132 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 90

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 90

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1104803816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 HEALTH PARK DR DEPT OF",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274525",
            "telephone_number": "615-372-5004",
            "fax_number": "866-831-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MO PAC EXPWY NORTH",
            "address_2": "DEPT OF CARDIOLOGY",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78758",
            "telephone_number": "512-901-4001",
            "fax_number": "512-901-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE AUSTIN DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "REBOK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-372-5004"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140347904",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.

Verify at the official NPI Registry.