Brazosport Eye Facility, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

157 Issued in TX

Legal business name

BRAZOSPORT EYE FACILITY, INC.

Doing business as

Brazosport Eye Institute

Practice address

103 Parking Way St
Lake Jackson, TX 77566-5228

Phone

(979) 297-2961

Fax

(979) 297-2395

NPI assigned

Feb 22, 2007

Last updated

Aug 10, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna Grady

Title

Administrator

Phone

(979) 297-2961

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brazosport Eye Institute Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396870028. Details of each certification follow.

• CCN 45C0001058 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 45C0001058

Legal name

BRAZOSPORT EYE INSTITUTE

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Mar 12, 1986

Last certification

Jun 20, 2017

Ownership / control type

Proprietary

Facility address

103 Parking Way
Lake Jackson, TX 77566

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.

• Jonathan Patrick Grady, M.D.

  • Ophthalmology Physician
  • Lake Jackson, TX
  • NPI 1386838563
  NPD

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1396870028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 PARKING WAY ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665228",
            "telephone_number": "979-297-2961",
            "fax_number": "979-297-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 PARKING WAY ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665228",
            "telephone_number": "979-297-2961",
            "fax_number": "979-297-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOSPORT EYE FACILITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "GRADY",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "979-297-2961"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085885401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brazosport Eye Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brazos River Emergency Physicians PLLC
• Brazosport Cardiology, P.a. (Pearland Heart Institute)
• Brazosport Clinical Lab
• Brazosport Dermatology Clinic PA
• Brazosport Ear, Nose & Throat Clinic, PA
• Brazosport Health Alliance
• Brazosport Health Alliance
• Brazosport Pediatric Clinic, P.a.
• Brazosport Professional Eye Clinic Inc (Mark A Provenzano OD)
• Brazosport Psychiatric Clinic (Matthew Brams MD Alice Mao MD)

• Ambulatory Surgical Clinic/Center in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.