NPIMap

Organization Active NPI

Pedernales Medical Group LLP

  • Internal Medicine Physician
  • Fredericksburg, TX
National Provider Identifier
1124076674
Registry record updated Apr 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PEDERNALES MEDICAL GROUP LLP
Practice address
205 W Windcrest St
Suite 310
Fredericksburg, TX 78624-4479
Phone
(830) 997-2191
Fax
(830) 997-8202
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2015

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

Authorized official

Name
Daniel R Thompson
Title
Office Manager
Phone
(830) 997-2191

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

205 W Windcrest St
Suite 310
Fredericksburg, TX 78624-4479

Mailing address

205 W Windcrest St
Suite 310
Fredericksburg, TX 78624-4479
Phone (830) 997-2191

Other identifiers 1

IdentifierTypeStateIssuer
080710903MedicaidTX

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13457/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428364800000",
    "number": "1124076674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W WINDCREST ST",
            "address_2": "SUITE 310",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244479",
            "telephone_number": "830-997-2191",
            "fax_number": "830-997-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W WINDCREST ST",
            "address_2": "SUITE 310",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786244479",
            "telephone_number": "830-997-2191",
            "fax_number": "830-997-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERNALES MEDICAL GROUP LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2015-04-07",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "830-997-2191"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080710903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.