NPIMap

Organization Active NPI

Brazos Valley Physicians Organization,Mso-LLC

  • Interventional Pain Medicine Physician
  • Bryan, TX
National Provider Identifier
1366299539
Registry record updated May 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
BRAZOS VALLEY PHYSICIANS ORGANIZATION,MSO-LLC
Practice address
3201 University Dr E Ste 470
Bryan, TX 77802-3487
Phone
(979) 731-3906
Fax
(979) 774-1253
NPI assigned
May 4, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2024

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

3201 University Dr E Ste 470
Bryan, TX 77802-3487

Mailing address

3131 University Dr E
Bryan, TX 77802-3473

Other names 1

  • The Physicians Pain and Spine Centre Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231107001459 TX Part B Supplier - Clinic/Group Practice 4789574153 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Bryan, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

3131 University Dr E
Ste 240
Bryan, TX 77802
Phone (979) 731-3100

3201 University Dr E
Ste 320
Bryan, TX 77802
Phone (979) 704-5029

Practitioners & affiliated clinicians

Practitioners 9

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": "1714780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714780800000",
    "number": "1366299539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 UNIVERSITY DR E",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 UNIVERSITY DR E STE 470",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023487",
            "telephone_number": "979-731-3906",
            "fax_number": "979-774-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS VALLEY PHYSICIANS ORGANIZATION,MSO-LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-04",
        "last_updated": "2024-05-04",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Physicians Pain and Spine Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.