Individual provider Active NPI

Bharat Nandgaonkar, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Killeen, TX
National Provider Identifier
1164563599
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
K4509 Issued in TX
Practice address
2201 Clear Creek Rd
Killeen, TX 76549-4110
Phone
(254) 526-7523
NPI assigned
Feb 9, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X K4509 TX Primary

Addresses

Primary practice location

2201 Clear Creek Rd
Killeen, TX 76549-4110

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-8800

Other identifiers 1

IdentifierTypeStateIssuer
036099183MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bnandgaonkar11151@direct.sw.org Direct

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110927000505 TX Practitioner - Pediatric MedicinePractitioner - Other (Physician) 6103097944 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K4509TXMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott and White Clinic CurrentSince Jul 30, 2012 Accepting new patients
Scott & White Clinic CurrentSince Jul 30, 2012 Accepting new patients
Scott & White Clinic Current Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients
Scott & White Hospital - College Station Past Accepting new patients

Locations

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

700 Scott and White Dr
College Station, TX 77845
Phone (979) 207-0100

1280 Arrington Rd
Ste 200
College Station, TX 77845
Phone (979) 207-6550

2201 Clear Creek Rd
Killeen, TX 76549
Phone (254) 519-8185

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1164563599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 CLEAR CREEK RD",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765494110",
            "telephone_number": "254-526-7523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANDGAONKAR",
        "first_name": "BHARAT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TX",
            "license": "K4509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036099183",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bnandgaonkar11151@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2201 Clear Creek Rd",
            "city": "Killeen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765494110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.