Gerald W Bottenfield, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G4086 Issued in TX

Practice address

210 Lake Rd Ste 600
Lake Jackson, TX 77566-4982

Phone

(979) 297-7337

Fax

(979) 297-9096

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bottenfield Pediatric Associates, PLLC

  • Pediatrics Physician
  • Lake Jackson, TX
  • NPI 1710540513

  Pediatrics

  NPD Authorized official

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576713600000",
    "number": "1124084231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 LAKE RD STE 600",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775664982",
            "telephone_number": "979-297-7337",
            "fax_number": "979-266-9076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 LAKE RD STE 600",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775664982",
            "telephone_number": "979-297-7337",
            "fax_number": "979-297-9096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 That Way St # A-1",
            "address_purpose": "LOCATION",
            "city": "Lake Jackson",
            "state": "TX",
            "postal_code": "775665211",
            "country_code": "US",
            "telephone_number": "979-297-7337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTTENFIELD",
        "first_name": "GERALD",
        "middle_name": "W",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "G4086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121182303",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "82971Y",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121182304",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blinn Stewart Bolcar-Lunsford, RN, MSN, FNP-C
• Melodie Bond, MA, LPC
• Sarah Alene Bookout
• Javeed Bora
• Bottenfield Pediatric Associates, PLLC
• Paul Frederick Boven, DDS
• Lucretia Sheree' Boyd, FNP
• Staci Schneider Braden, D.C.
• Stephani Curtis Bradley, FNP
• Brazoria County Dialysis LLP

• All providers in Lake Jackson, TX
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.