Individual provider Active NPI

Nichole Jeanetta Van de Putte, M.D.

  • Obstetrics & Gynecology Physician
  • San Antonio, TX
National Provider Identifier
1124288626
Registry record updated Aug 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
P2555 Issued in TX
Practice address
1102 Barclay St
San Antonio, TX 78207-7161
Phone
(210) 233-7000
Fax
(210) 434-1704
NPI assigned
Jun 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X P2555 TX Primary

Addresses

Primary practice location

1102 Barclay St
San Antonio, TX 78207-7161

Mailing address

3066 E Commerce St
San Antonio, TX 78220-1013
Phone (210) 233-7000

Other identifiers 1

IdentifierTypeStateIssuer
301049802MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120808000958 TX Practitioner - Obstetrics/Gynecology 6800042714 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Texas Medical School at San Antonio, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barrio Comprehensive Family Health Care Center,IncGroup PAC ID 1153226691, 63 clinicians

Practice addresses (Care Compare)

1102 Barclay St
San Antonio, TX 78207-7161
Phone (210) 434-2368

Hospital & facility affiliations

  • Methodist Hospital Hospital, San Antonio, TX, CCN 450388

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P2555TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Obhg Texas Holdings, P.a. Obstetrics & Gynecology CurrentSince Jul 1, 2023 Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc. Current Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc. CurrentSince May 16, 2016 Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc CurrentSince May 16, 2016 Accepting new patients
Methodist Healthcare System of San Antonio, LTD., L.L.P. Past Accepting new patients

Locations

1600 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2000

12221 N Mopac Expy
Austin, TX 78758
Phone (512) 901-2530

2830 Calder St
Beaumont, TX 77702
Phone (409) 899-7000

5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (321) 917-9263

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000

1102 Barclay St
San Antonio, TX 78207
Phone (210) 434-0513

14625 Huebner Rd
San Antonio, TX 78230

1310 McCullough Ave
San Antonio, TX 78212
Phone (210) 208-2200

3066 E Commerce St
San Antonio, TX 78220
Phone (210) 233-7062

Interoperability endpoints

  • Direct secure messaging: nichole.vandeputte@commsa.eclinicaldirectplus.com

Organizations & group practices 5

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501804800000",
    "number": "1124288626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3066 E COMMERCE ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782201013",
            "telephone_number": "210-233-7000",
            "fax_number": "210-277-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BARCLAY ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782077161",
            "telephone_number": "210-233-7000",
            "fax_number": "210-434-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE PUTTE",
        "first_name": "NICHOLE",
        "middle_name": "JEANETTA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2017-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "P2555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301049802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.