NPIMap

Organization Active NPI

Bsa Hospital LLC

  • Vascular & Interventional Radiology Physician
  • Amarillo, TX
National Provider Identifier
1609112069
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
BSA HOSPITAL LLC
Practice address
1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone
(806) 212-2000
Fax
(806) 212-8836
NPI assigned
Dec 12, 2012
Last updated
Dec 12, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
BSA HEALTH SYSTEM OF AMARILLO LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Authorized official

Name
Stephen C Petrovich
Title
SVP
Phone
(615) 296-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

1600 Wallace Blvd
Amarillo, TX 79106-1799

Mailing address

1 Burton Hills Blvd
Suite 250
Nashville, TN 37215-6293
Phone (615) 296-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130212000300 TX Part B Supplier - Clinic/Group Practice 6305090762 Receives reassigned benefits from 32 practitioners
1 other NPI on this enrollment
Practice locations: Amarillo, TX

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bsa Hospital LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rehabilitation Hospital of AmarilloAmarillo, TX, CCN 743035 Hospital 5% Or Greater Direct Ownership Interest (49%) Aug 8, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355270400000",
    "number": "1609112069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURTON HILLS BLVD",
            "address_2": "SUITE 250",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156293",
            "telephone_number": "615-296-3000",
            "fax_number": "615-296-6011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-2000",
            "fax_number": "806-212-8836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BSA HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BSA HEALTH SYSTEM OF AMARILLO LLC",
        "enumeration_date": "2012-12-12",
        "last_updated": "2012-12-12",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.