Brazosport Radiology PLLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

BRAZOSPORT RADIOLOGY PLLC

Practice address

100 Medical Dr
Lake Jackson, TX 77566-5674

Phone

(979) 285-1937

NPI assigned

Apr 14, 2007

Organization subpart

No

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

Authorized official

Name

Craig Freedman, M.D.

Title

President

Phone

(979) 285-1937

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

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

• Ronald L Brociner, MD

  • Diagnostic Radiology Physician
  • Lake Jackson, TX
  • NPI 1225001092

  Diagnostic Radiology

  NPD (past)

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

{
    "created_epoch": "1176508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1497970669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL DR",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665674",
            "telephone_number": "979-285-1937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOSPORT RADIOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-14",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "FREEDMAN",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "979-285-1937",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196064301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DO3043",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brazosport Health Alliance
• Brazosport Health Alliance
• Brazosport Pediatric Clinic, P.a.
• Brazosport Professional Eye Clinic Inc
• Brazosport Psychiatric Clinic
• Brazosport Regional Physician Services
• Brazosport Rehabilitation & Wellness, LLC
• Brazosport Speech Pathology Services, PLLC
• Brazosport Urology, PA
• Brazosport Womens Health PA

• All providers in Lake Jackson, TX
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.