NPIMap

Organization Active NPI

Gulfside Medical Clinic of Texas, PA

  • Family Medicine Physician
  • Rockport, TX
National Provider Identifier
1386653277
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J0446 Issued in TX
Legal business name
GULFSIDE MEDICAL CLINIC OF TEXAS, PA
Practice address
1209 Highway 35 N
Suite a
Rockport, TX 78382-3117
Phone
(361) 729-9811
Fax
(361) 729-9819
NPI assigned
Aug 7, 2006
Last updated
Nov 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Jack H Brackin, M.D.NPI 1164431078
Title
Owner / Physician
Phone
(361) 729-9811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J0446 TX Primary

Addresses

Primary practice location

1209 Highway 35 N
Suite a
Rockport, TX 78382-3117

Mailing address

1209 Highway 35 N
Suite a
Rockport, TX 78382-3117
Phone (361) 729-9811

Other identifiers 1

IdentifierTypeStateIssuer
0025PWOtherTXBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1386653277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 HIGHWAY 35 N",
            "address_2": "SUITE A",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823117",
            "telephone_number": "361-729-9811",
            "fax_number": "361-729-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 HIGHWAY 35 N",
            "address_2": "SUITE A",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783823117",
            "telephone_number": "361-729-9811",
            "fax_number": "361-729-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSIDE MEDICAL CLINIC OF TEXAS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "BRACKIN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER / PHYSICIAN",
        "authorized_official_telephone_number": "361-729-9811",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J0446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0025PW",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockport, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; 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.