NPIMap

Organization Active NPI

Christus Pediatric Physician Group

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1346652575
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHRISTUS PEDIATRIC PHYSICIAN GROUP
Practice address
100 NE Loop 410
Suite 800
San Antonio, TX 78216
Phone
(210) 704-8706
Fax
(210) 704-4695
NPI assigned
May 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Authorized official

Name
Clinton Kotal
Title
Executive Director
Phone
(210) 704-8706

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

100 NE Loop 410
Suite 800
San Antonio, TX 78216

Mailing address

100 NE Loop 410
Suite 800
San Antonio, TX 78216-4700
Phone (210) 704-8706

Other names 1

  • Children's Hospital of San Antonio Physician Group Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

311 Buddy Ganem Dr
#A
Portland, TX 78374
Phone (361) 777-0500

11503 NW Military Hwy
San Antonio, TX 78231
Phone (210) 233-6363

21727 W Interstate 10
San Antonio, TX 78257
Phone (210) 455-1091

11503 NW Military Hwy
Ste 13
San Antonio, TX 78231

3510 Richmond Rd
Ste 100
Texarkana, TX 75503
Phone (903) 614-5220

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1346652575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NE LOOP 410",
            "address_2": "SUITE 800",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164700",
            "telephone_number": "210-704-8706",
            "fax_number": "210-704-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NE LOOP 410",
            "address_2": "SUITE 800",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78216",
            "telephone_number": "210-704-8706",
            "fax_number": "210-704-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS PEDIATRIC PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "KOTAL",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "210-704-8706"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Hospital of San Antonio Physician Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Hospital of San Antonio Physician Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; 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.