Active NPI
Grace Rustom
- Family Medicine Physician
- Galveston, TX
National Provider Identifier
1154114478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- BP10094059
- Practice address
- 712 Texas Ave
Galveston, TX 77555-0001 - Phone
- (409) 772-2222
- NPI assigned
- May 28, 2025
- Last updated
- May 28, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | BP10094059 | TX | Primary |
Addresses
Primary practice location
712 Texas Ave
Galveston, TX 77555-0001
Mailing address
301 University Blvd
Galveston, TX 77555-5302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250604003931 | TX | Order and Referring Only - Family Practice | 6305355835 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748390400000",
"number": "1154114478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 UNIVERSITY BLVD",
"city": "GALVESTON",
"state": "TX",
"postal_code": "775555302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 TEXAS AVE",
"city": "GALVESTON",
"state": "TX",
"postal_code": "775550001",
"telephone_number": "409-772-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSTOM",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-28",
"last_updated": "2025-05-28",
"certification_date": "2025-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "BP10094059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galveston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.