NPIMap

Organization Active NPI

Preventiamed, PA

  • Internal Medicine Physician
  • West Lake Hills, TX
National Provider Identifier
1134344625
Registry record updated Oct 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PREVENTIAMED, PA
Practice address
1250 S Capital of Texas Hwy
Building III, Suite 400
West Lake Hills, TX 78746-6446
Phone
(512) 308-6349
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2010

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

Authorized official

Name
Dr. Dieter Robert Martin, M.D.
Title
President
Phone
(512) 308-6349

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1250 S Capital of Texas Hwy
Building III, Suite 400
West Lake Hills, TX 78746-6446

Mailing address

1250 S Capital of Texas Hwy
Building III, Suite 400
West Lake Hills, TX 78746-6446
Phone (512) 308-6349

Other identifiers 1

IdentifierTypeStateIssuer
182571301MedicaidTX

National Provider Directory

National Provider Directory

Locations

1250 S Capital of Texas Hwy
Bldg Iii
West Lake Hills, TX 78746
Phone (512) 308-6349

Practitioners & affiliated clinicians

Practitioners 9

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287792000000",
    "number": "1134344625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 S CAPITAL OF TEXAS HWY",
            "address_2": "BUILDING III, SUITE 400",
            "city": "WEST LAKE HILLS",
            "state": "TX",
            "postal_code": "787466446",
            "telephone_number": "512-308-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S CAPITAL OF TEXAS HWY",
            "address_2": "BUILDING III, SUITE 400",
            "city": "WEST LAKE HILLS",
            "state": "TX",
            "postal_code": "787466446",
            "telephone_number": "512-308-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIAMED, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2010-10-23",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DIETER",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-308-6349",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182571301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Lake Hills, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2010; 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.