Active NPI
Rockdale Blackhawk LLC
- Critical Access Hospital
- Rockdale, TX
National Provider Identifier
1306933692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Access Hospital
- License
- 000369
- Legal business name
- ROCKDALE BLACKHAWK LLC
- Practice address
- 1700 Brazos Ave
Rockdale, TX 76567-2517 - Phone
- (512) 446-4500
- Fax
- (512) 446-2063
- NPI assigned
- Oct 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeffrey P Madison
- Title
- Ceo
- Phone
- (512) 446-4500
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Critical Access Hospital | 282NC0060X | 000369 | TX | Primary |
Addresses
Primary practice location
1700 Brazos Ave
Rockdale, TX 76567-2517
Mailing address
PO Box 1010
Rockdale, TX 76567-1010
Phone (512) 446-4500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DF5837 | Other | TX | MEDICARE RAIL ROAD |
| 00X082 | Other | TX | MEDICARE PART B |
| 183086101 | Medicaid | TX |
Other names 1
- Little River Healthcare
National Provider Directory
National Provider DirectoryLocations
3101 Highway 71 E
Ste 108
Bastrop, TX 78602
Phone (512) 321-8200
1700 Brazos Ave
Ste A
Rockdale, TX 76567
Phone (512) 446-4500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1333324800000",
"number": "1306933692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1010",
"city": "ROCKDALE",
"state": "TX",
"postal_code": "765671010",
"telephone_number": "512-446-4500",
"fax_number": "512-446-2063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 BRAZOS AVE",
"city": "ROCKDALE",
"state": "TX",
"postal_code": "765672517",
"telephone_number": "512-446-4500",
"fax_number": "512-446-2063"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROCKDALE BLACKHAWK LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-06",
"last_updated": "2012-04-02",
"status": "A",
"authorized_official_last_name": "MADISON",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "512-446-4500"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "TX",
"license": "000369",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD",
"identifier": "DF5837",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "00X082",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "183086101",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Little River Healthcare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rockdale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.