NPIMap

Organization Active NPI

Brazos Valley Oms PLLC

Doing business as Brazos Valley Oral & Maxillofacial Surgery

  • Dentist
  • College Station, TX
National Provider Identifier
1194931303
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10404 Issued in TX
Legal business name
BRAZOS VALLEY OMS PLLC
Doing business as
Brazos Valley Oral & Maxillofacial Surgery
Practice address
1505 Emerald Plaza
College Station, TX 77845-1501
Phone
(979) 764-7101
Fax
(979) 764-7115
NPI assigned
May 15, 2007
Last updated
Jan 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Authorized official

Name
James Bryan Garrett, DDS, MDNPI 1184910838
Title
Owner/Surgeon
Phone
(979) 764-7101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 10404 TX Primary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 10460 TX
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 10404 TX

Addresses

Primary practice location

1505 Emerald Plaza
College Station, TX 77845-1501

Mailing address

1505 Emerald Plaza
College Station, TX 77845-1501
Phone (979) 764-7101

Other identifiers 1

IdentifierTypeStateIssuer
813315OtherTNUNITED CONCORDIA

Other names 1

  • Brazos Valley Oral & Maxillofacial Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201022000800 TX Part B Supplier - Clinic/Group Practice 3173943651 Receives reassigned benefits from 5 practitioners
Practice locations: Brenham, TX; College Station, TX

National Provider Directory

National Provider Directory

Locations

1704 S Blue Bell Rd
Brenham, TX 77833
Phone (979) 764-7101

1505 Emerald Plz
College Station, TX 77845
Phone (979) 764-7101

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1194931303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLAZA",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101",
            "fax_number": "979-764-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLAZA",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101",
            "fax_number": "979-764-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS VALLEY OMS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "GARRETT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER/SURGEON",
        "authorized_official_telephone_number": "979-764-7101",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "10404",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "10460",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "10404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "813315",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brazos Valley Oral & Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.