NPIMap

Organization Active NPI

Seton Oral & Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Austin, TX
National Provider Identifier
1124598917
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
SETON ORAL & MAXILLOFACIAL SURGERY
Practice address
901 W 38TH St
Suite 410
Austin, TX 78705
Phone
(512) 992-1378
Fax
(512) 992-1379
NPI assigned
Dec 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Authorized official

Name
Clayton Carsner
Title
VP/Coo
Phone
(512) 324-5846

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

901 W 38TH St
Suite 410
Austin, TX 78705

Mailing address

1345 Philomena St
Ste 410.3
Austin, TX 78723
Phone (512) 992-1378

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190129001320 TX Part B Supplier - Clinic/Group Practice 7113951377 Receives reassigned benefits from 7 practitioners
Practice locations: Austin, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1124598917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345 PHILOMENA ST",
            "address_2": "STE 410.3",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78723",
            "telephone_number": "512-992-1378",
            "fax_number": "512-992-1379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W 38TH ST",
            "address_2": "SUITE 410",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78705",
            "telephone_number": "512-992-1378",
            "fax_number": "512-992-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SETON ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-05",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "CARSNER",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "512-324-5846"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "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 Jul 22, 2019; 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.