Linda J. Banta, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J3779 Issued in TX

Practice address

109 Gallery Cir
Suite 135
San Antonio, TX 78258-3327

Phone

(210) 494-0504

Fax

(210) 494-0593

NPI assigned

Aug 10, 2005

Last updated

Jun 4, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Linda Jane Deloach Banta Former name

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

Specialty

Dermatology

Education

Uniformed Services Uhs Fe Hebert School of Med, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Linda J. Banta, M.D., P.a.Group PAC ID 5294868535, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lindabanta@stoneoak.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Linda J. Banta, M.D., P.a.

  dba Stone Oak Dermatology

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1013231216
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275609600000",
    "number": "1144221359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2493",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782992493",
            "telephone_number": "210-494-0504",
            "fax_number": "210-494-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 GALLERY CIR",
            "address_2": "SUITE 135",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583327",
            "telephone_number": "210-494-0504",
            "fax_number": "210-494-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTA",
        "first_name": "LINDA",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2010-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J3779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "81342X",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CK2746",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDA",
            "last_name": "DELOACH BANTA",
            "middle_name": "JANE",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Swetha Reddy Banswada, M.D
• Surbhi Banubakode
• Angelina S Banuelos-Gonzalez, RDN
• Alma Banuelos, LPC-S
• Elizabeth Banuelos, COTA
• Polo Alberto Banuelos, M.D.

• Dermatology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.