Medberry Health PLLC
Organization Active NPI General Practice Physician · San Antonio, TX
NPI 1487301867 · NPPES record last updated Jan 31, 2023
Key facts
- NPI
- 1487301867
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- MEDBERRY HEALTH PLLC
- Practice address
- 4749 Fredericksburg Rd Ste a
San Antonio, TX 78229-4465 - Phone
- (210) 997-8630
- NPI assigned
- Mar 7, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Luke Berry, MD
- Title
- Owner
- Phone
- (210) 997-8630
Practitioners 6
-
Nicholas Edward O'Bright, M.D.
-
Shelly Rae Russeff, APRN-CNP
-
Jennifer Glenn, APRN-CNP
-
Marian Gail Culpepper, APRN-CNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2267897 | Medberry Health PLLC | Certificate of waiver | Aug 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220715000227 | OK | Part B Supplier - Clinic/Group Practice | 0244627099 |
Receives reassigned benefits from 2 practitioners Practice locations: The Village, OK |
National Provider Directory
Locations
10717 N May Ave
Ste A
The Village, OK 73120
Phone (405) 849-5959
4749 Fredericksburg Rd
San Antonio, TX 78229
Phone (210) 997-8630
4800 US Highway 281 N
Unit 1
Spring Branch, TX 78070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| General Practice Physician |
208D00000X | Yes | ||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
4749 Fredericksburg Rd Ste a
San Antonio, TX 78229-4465
Mailing address
4749 Fredericksburg Rd Ste a
San Antonio, TX 78229-4465
Other practice location 1
10717 N May Ave
Oklahoma City, OK 73120-2620
Phone (210) 997-8630
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All providers in San Antonio, TX · General Practice Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.