Broadway Medical Clinic, P.a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

F7365 Issued in TX

Legal business name

BROADWAY MEDICAL CLINIC, P.A.

Practice address

3208 Broadway St
Houston, TX 77017-2321

Phone

(713) 641-5656

Fax

(713) 641-5293

NPI assigned

Sep 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. J. Felipe Nieto, M.D.

Title

President/Medical Director

Phone

(713) 641-5656

Specialties & licenses 1

Addresses

Other identifiers 7

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HEECDA

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1295830990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 BROADWAY ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770172321",
            "telephone_number": "713-641-5656",
            "fax_number": "713-641-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 BROADWAY ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770172321",
            "telephone_number": "713-641-5656",
            "fax_number": "713-641-5293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "NIETO",
        "authorized_official_first_name": "J. FELIPE",
        "authorized_official_title_or_position": "PRESIDENT/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "713-641-5656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "F7365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092059701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APS HEALTHCARE",
            "identifier": "900013387001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10004520",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10020679",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "000000U92M",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092059702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133829501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Broadhead, RD, LD, CNSC
• Stephanie Broadhurst, MSN, RN, IBCLC
• Broadstone Neurology Group LLC
• Broadway Dental & Braces PLLC
• Broadway Health Group LLC
• Broadway Pharmacy
• Broadway Tho PLLC
• Jacqueline B. Broadway, MSN, FNP
• Kristen Leigh Broadway, LPC-S
• Sammi Geann Rae Estrellado Broadwell

• Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.