NPIMap

Organization Active NPI

Brazos Valley Physicians Alliance

Doing business as Central Texas Sports Medicine & Orthopaedics

  • Orthopaedic Surgery Physician
  • Bryan, TX
National Provider Identifier
1609493543
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
BRAZOS VALLEY PHYSICIANS ALLIANCE
Doing business as
Central Texas Sports Medicine & Orthopaedics
Practice address
3121 University Dr E Ste 100
Bryan, TX 77802-3499
Phone
(979) 776-0169
Fax
(979) 776-1372
NPI assigned
Jun 26, 2020
Last updated
Jun 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5900

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Emergency Medicine) Physician 207PS0010X NU
Family Medicine Physician 207Q00000X NU
Orthopaedic Surgery Physician 207X00000X NU Primary
Sports Physical Therapist 2251S0007X NU

Addresses

Primary practice location

3121 University Dr E Ste 100
Bryan, TX 77802-3499

Mailing address

3121 University Dr E Ste 100
Bryan, TX 77802-3499
Phone (979) 776-0169

Other names 1

  • Central Texas Sports Medicine & Orthopaedics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200702000466 TX DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1052604006 Practice locations: Bryan, TX

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

3121 University Dr E
Ste 100
Bryan, TX 77802
Phone (979) 776-0169

3201 University Dr E
Ste 255A
Bryan, TX 77802
Phone (979) 731-3930

3201 University Dr E
Ste 455
Bryan, TX 77802
Phone (979) 704-5029

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593129600000",
    "number": "1609493543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 UNIVERSITY DR E STE 100",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023499",
            "telephone_number": "979-776-0169",
            "fax_number": "979-776-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 UNIVERSITY DR E STE 100",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023499",
            "telephone_number": "979-776-0169",
            "fax_number": "979-776-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOS VALLEY PHYSICIANS ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5900"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Texas Sports Medicine & Orthopaedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; 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.