Individual provider Active NPI

Bret Thomas Ackermann, DO

  • Emergency Medicine Physician
  • Jbsa Ft Sam Houston, TX
National Provider Identifier
1316010747
Registry record updated Apr 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
S4709 Issued in TX
Practice address
3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504
Phone
(210) 916-2338
Fax
(210) 916-5102
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 34.014397 OH
Emergency Medicine Physician 207P00000X 056765 FL
Emergency Medicine Physician 207P00000X S4709 TX Primary

Addresses

Primary practice location

3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504

Mailing address

104 Canyon Cir
Boerne, TX 78015-8300
Phone (717) 385-9031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210603000308 TX Practitioner - Emergency Medicine 0941623078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Nova Southeastern College of Osteo Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Medical Group of Texas PLLCGroup PAC ID 7810117223, 319 clinicians

Practice addresses (Care Compare)

200 S Interstate 35
Pearsall, TX 78061-6601
Phone (830) 334-3617

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
056765FLMDEmergency Medicine Physician
S4709TXMDEmergency Medicine Physician
34.014397OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Apr 19, 2021 Accepting new patients

Locations

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

200 S Interstate 35
Pearsall, TX 78061
Phone (888) 250-2326

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682121600000",
    "number": "1316010747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CANYON CIR",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780158300",
            "telephone_number": "717-385-9031",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-2338",
            "fax_number": "210-916-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKERMANN",
        "first_name": "BRET",
        "middle_name": "THOMAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-04-22",
        "certification_date": "2023-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.014397",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "056765",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "S4709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jbsa Ft Sam Houston, TX

Sources for this page

Verify at the official NPI Registry.