NPIMap

Organization Active NPI

Pondworks PA

  • Psychiatry Physician
  • Austin, TX
National Provider Identifier
1124139506
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
L8767 Issued in TX
Legal business name
PONDWORKS PA
Practice address
3636 Executive Center Dr Ste G70
Austin, TX 78731-1628
Phone
(512) 371-9555
Fax
(512) 367-5756
NPI assigned
Aug 31, 2006
Last updated
Mar 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

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

Authorized official

Name
Dr. Bernard C. Kim, M.D.NPI 1528074952
Title
Physician
Phone
(512) 371-9555

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
Psychiatry Physician 2084P0800X L8767 TX Primary

Addresses

Primary practice location

3636 Executive Center Dr Ste G70
Austin, TX 78731-1628

Mailing address

3636 Executive Center Dr Ste G70
Austin, TX 78731-1628
Phone (512) 371-9555

National Provider Directory

National Provider Directory

Locations

3636 Executive Center Dr
Ste G70
Austin, TX 78731
Phone (512) 371-9555

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1124139506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3636 EXECUTIVE CENTER DR STE G70",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311628",
            "telephone_number": "512-371-9555",
            "fax_number": "512-367-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 EXECUTIVE CENTER DR STE G70",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311628",
            "telephone_number": "512-371-9555",
            "fax_number": "512-367-5756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDWORKS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "512-371-9555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "L8767",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Mar 3, 2016; 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.