Active NPI
John J Bardgette, MD
- Nephrology Physician
- Waco, TX
National Provider Identifier
1417996208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- E2458
- Practice address
- 2329 N 39TH St
Waco, TX 76708-3003 - Phone
- (254) 752-5503
- Fax
- (254) 752-4844
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | E2458 | TX | Primary |
Addresses
Primary practice location
2329 N 39TH St
Waco, TX 76708-3003
Mailing address
2329 N 39TH St
Waco, TX 76708-3003
Phone (254) 752-5503
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119142101 | Medicaid | TX |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1417996208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2329 N 39TH ST",
"city": "WACO",
"state": "TX",
"postal_code": "767083003",
"telephone_number": "254-752-5503",
"fax_number": "254-752-4844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2329 N 39TH ST",
"city": "WACO",
"state": "TX",
"postal_code": "767083003",
"telephone_number": "254-752-5503",
"fax_number": "254-752-4844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARDGETTE",
"first_name": "JOHN",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "TX",
"license": "E2458",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119142101",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.