NPIMap

Organization Active NPI

Privia Medical Group Gulf Coast PLLC

Doing business as Premiere Sports and Family Medicine

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Bryan, TX
National Provider Identifier
1134901960
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
PRIVIA MEDICAL GROUP GULF COAST PLLC
Doing business as
Premiere Sports and Family Medicine
Practice address
3201 University Dr E Ste 245
Bryan, TX 77802-3483
Phone
(979) 731-3100
NPI assigned
Oct 17, 2023
Last updated
Oct 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Barbara Jordan, VP
Title
VP, Revenue Cycle Management
Phone
(713) 512-7613

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081S0010X Primary

Addresses

Primary practice location

3201 University Dr E Ste 245
Bryan, TX 77802-3483

Mailing address

1200 Binz St Ste 1490
Houston, TX 77004-6946
Phone (713) 512-7700

Other names 1

  • Premiere Sports and Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Katy Advanced OBGYN PLLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1134901960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 BINZ ST STE 1490",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770046946",
            "telephone_number": "713-512-7700",
            "fax_number": "832-767-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 UNIVERSITY DR E STE 245",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023483",
            "telephone_number": "979-731-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP GULF COAST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "VP, REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "713-512-7613",
        "authorized_official_credential": "VP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premiere Sports and Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.