Organization Active NPI

Third Coast Emergency Physicians Southwest PA

  • Emergency Medicine Physician
  • San Antonio, TX
National Provider Identifier
1497793475
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
THIRD COAST EMERGENCY PHYSICIANS SOUTHWEST PA
Practice address
4103 North Look 1604 W
San Antonio, TX 78249-1395
Phone
(330) 493-4443
NPI assigned
Jun 3, 2006
Last updated
Oct 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Sam Roberts, MD
Title
President
Phone
(512) 452-8533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

4103 North Look 1604 W
San Antonio, TX 78249-1395

Mailing address

4535 Dressler Rd NW
Canton, OH 44718-2545
Phone (330) 493-4443

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031222000126 TX Part B Supplier - Clinic/Group Practice 6800794447 Receives reassigned benefits from 417 practitioners
Practice locations: San Antonio, TX; Schertz, TX; Lakeway, TX

National Provider Directory

National Provider Directory

Locations

6300 La Calma Dr
Ste 101
Austin, TX 78752

16088 San Pedro Ave
San Antonio, TX 78232
Phone (210) 402-4092

16977 Interstate 35 N
Schertz, TX 78154
Phone (210) 572-8400

Practitioners & affiliated clinicians

Practitioners 417

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.

View all 417

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1497793475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182545",
            "telephone_number": "330-493-4443",
            "fax_number": "330-493-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 NORTH LOOK 1604 W",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782491395",
            "telephone_number": "330-493-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD COAST EMERGENCY PHYSICIANS SOUTHWEST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-452-8533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 10, 2019; 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.