Bulverde Family Medicine PA

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

Legal business name

BULVERDE FAMILY MEDICINE PA

Practice address

805 Kelly Creek Rd
Bulverde, TX 78163-3035

Phone

(830) 980-1805

Fax

(830) 438-5662

NPI assigned

Sep 17, 2015

Last updated

Jun 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeff D Ethridge, MDNPI 1154318095

Title

Physician Owner

Phone

(830) 980-1805

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22723/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Jeff D Ethridge, M.D.

  • Family Medicine Physician
  • Bulverde, TX
  • NPI 1154318095
  Authorized official Same address or phone

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1265801492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 KELLY CREEK RD",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781633035",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 KELLY CREEK RD",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781633035",
            "telephone_number": "830-980-1805",
            "fax_number": "830-438-5662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULVERDE FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-17",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "ETHRIDGE",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "830-980-1805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L6877",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386676601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "L6877",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Booher-Terry, LCSW
• Hannah Ellen Booth
• Bruce G. Kinzy, M.D., P.a.
• Lisa Larae Buendicho, LPC
• Bulverde Counseling
• Bulverde Point Dental, PLLC
• Bulverde Vision Center, PC (Bulverde Vision Source)
• Celeste Burt
• Mariza Lea Cardenas
• Breeann Carleton, LPC

• Hospitalist Physician in Bulverde, TX
• Providers in Bulverde, TX by specialty
• Hospitalist Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.