Individual provider Active NPI

Patrick Dale Nunnelly, MD

  • Obstetrics & Gynecology Physician
  • Austin, TX
National Provider Identifier
1386631117
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
E8769 Issued in TX
Practice address
1301 W 38TH St
Suite 300
Austin, TX 78705-1000
Phone
(512) 454-5721
Fax
(512) 454-2801
NPI assigned
Oct 6, 2005
Last updated
Jan 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X E8769 TX Primary

Addresses

Primary practice location

1301 W 38TH St
Suite 300
Austin, TX 78705-1000

Mailing address

1301 W 38TH St
Suite 300
Austin, TX 78705-1000
Phone (512) 454-5721

Other identifiers 1

IdentifierTypeStateIssuer
103126203MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The OBGYN Group of Austin PA Obstetrics & Gynecology CurrentSince Jul 1, 1985 Accepting new patients

Locations

1301 W 38th St
Ste 300
Austin, TX 78705
Phone (512) 454-5721

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1386631117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W 38TH ST",
            "address_2": "SUITE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051000",
            "telephone_number": "512-454-5721",
            "fax_number": "512-454-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W 38TH ST",
            "address_2": "SUITE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051000",
            "telephone_number": "512-454-5721",
            "fax_number": "512-454-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNNELLY",
        "first_name": "PATRICK",
        "middle_name": "DALE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "E8769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103126203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.