NPIMap

Organization Active NPI

BSZ Medical, P.a.

  • Family Medicine Physician
  • Pleasanton, TX
National Provider Identifier
1285934075
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L2066 Issued in TX
Legal business name
BSZ MEDICAL, P.A.
Practice address
1746 W Goodwin St
Pleasanton, TX 78064
Phone
(830) 268-5040
Fax
(800) 769-6492
NPI assigned
Oct 26, 2010
Last updated
Oct 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Authorized official

Name
Dr. Benjamin Scott Zertuche, MDNPI 1992788087
Title
Owner
Phone
(830) 268-5040

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L2066 TX Primary

Addresses

Primary practice location

1746 W Goodwin St
Pleasanton, TX 78064

Mailing address

1746 W Goodwin St
Pleasanton, TX 78064-4500
Phone (830) 268-5040

Other identifiers 1

IdentifierTypeStateIssuer
284051401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110228000582 TX Part B Supplier - Clinic/Group Practice 3779764584 Receives reassigned benefits from 19 practitioners
Practice locations: Pleasanton, TX
O20111220000477 TX Part A Provider - Rural Health Clinic 3779764584 Practice locations: Pleasanton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285934075. Details of each certification follow.

Rural health clinic certification: CCN 673926

Legal name
BSZ MEDICAL PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 5, 2013
Last certification
Sep 5, 2013
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Aug 25, 2010 in TX
Enrollment address
1746 W Goodwin St
Pleasanton, TX 78064-4500

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2027146BSZ Medical PA1746 W Goodwin Street, Pleasanton, TX 78064Certificate of waiverMar 6, 2028

National Provider Directory

National Provider Directory

Locations

1746 W Goodwin St
Pleasanton, TX 78064
Phone (830) 268-5040

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Benjamin S Zertuche Individual 5% Or Greater Direct Ownership Interest Jun 28, 2010 100%
Corporate OfficerPresident Aug 25, 2010 100%
W-2 Managing EmployeePresident Aug 25, 2010 100%
Adriana T Williams Individual W-2 Managing EmployeeAd; Apr 1, 2019 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727913600000",
    "number": "1285934075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 W GOODWIN ST",
            "city": "PLEASANTON",
            "state": "TX",
            "postal_code": "780644500",
            "telephone_number": "830-268-5040",
            "fax_number": "800-769-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 W GOODWIN ST",
            "city": "PLEASANTON",
            "state": "TX",
            "postal_code": "78064",
            "telephone_number": "830-268-5040",
            "fax_number": "800-769-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BSZ MEDICAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-26",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A",
        "authorized_official_last_name": "ZERTUCHE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-268-5040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L2066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284051401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, TX

Sources for this page

Verify at the official NPI Registry.