NPIMap

Organization Active NPI

Austin Regional Clinic, PA

  • Durable Medical Equipment & Medical Supplies
  • Bastrop, TX
National Provider Identifier
1346994373
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
AUSTIN REGIONAL CLINIC, PA
Practice address
622 W State Hwy 71
Ste 102
Bastrop, TX 78602-4234
Phone
(512) 308-4311
Fax
(512) 406-7397
NPI assigned
Feb 8, 2022
Last updated
Feb 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Anas Daghestani, MD
Title
Ceo
Phone
(512) 419-0707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

622 W State Hwy 71
Ste 102
Bastrop, TX 78602-4234

Mailing address

6210 E US Hwy 290
Suite 240 - Credentialing
Austin, TX 78723-1098
Phone (512) 338-3802

Other identifiers 1

IdentifierTypeStateIssuer
1333940-07MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Brodie Lane Medical Ass9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

622 W State Highway 71
Ste 102
Bastrop, TX 78602
Phone (512) 308-4311

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1346994373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 E US HWY 290",
            "address_2": "SUITE 240 - CREDENTIALING",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231098",
            "telephone_number": "512-338-3802",
            "fax_number": "512-406-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W STATE HWY 71",
            "address_2": "STE 102",
            "city": "BASTROP",
            "state": "TX",
            "postal_code": "786024234",
            "telephone_number": "512-308-4311",
            "fax_number": "512-406-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUSTIN REGIONAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "DAGHESTANI",
        "authorized_official_first_name": "ANAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-419-0707",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1333940-07",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.