NPIMap

Organization Active NPI

Diabetes and Glandular Disease Clinic PA

  • Endocrinology, Diabetes & Metabolism Physician
  • San Antonio, TX
National Provider Identifier
1427166305
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
DIABETES AND GLANDULAR DISEASE CLINIC PA
Practice address
5107 Medical Dr
San Antonio, TX 78229
Phone
(210) 614-8612
Fax
(210) 615-5596
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Authorized official

Name
Dr. Jacob Vadakekalam, MDNPI 1316904139
Title
President
Phone
(210) 615-5541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

5107 Medical Dr
San Antonio, TX 78229

Mailing address

5107 Medical Dr
San Antonio, TX 78229
Phone (210) 614-8612

Other identifiers 1

IdentifierTypeStateIssuer
121762202MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000006 TX Part B Supplier - Clinic/Group Practice 3375443930 Receives reassigned benefits from 26 practitioners
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory
Tax ID family
Diabetes and Glandular Disease Clinic Certified Diabetes Education Cen2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1427166305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5107 MEDICAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78229",
            "telephone_number": "210-614-8612",
            "fax_number": "210-615-5596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 MEDICAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78229",
            "telephone_number": "210-614-8612",
            "fax_number": "210-615-5596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES AND GLANDULAR DISEASE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "VADAKEKALAM",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-615-5541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121762202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.