NPIMap

Individual provider Active NPI

John Bruce Addison, D.O.

  • Family Medicine Physician
  • Colorado City, TX
National Provider Identifier
1629094552
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J1829 Issued in TX
Practice address
997 W Interstate 20
Colorado City, TX 79512-2685
Phone
(325) 728-2693
Fax
(325) 728-2420
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J1829 TX Primary

Addresses

Primary practice location

997 W Interstate 20
Colorado City, TX 79512-2685

Mailing address

997 W Interstate 20
Colorado City, TX 79512-3998
Phone (325) 728-2693

Other identifiers 1

IdentifierTypeStateIssuer
J1829OtherTXLICENSE

Other names 1

  • Bruce Addison Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041108000361 TX Practitioner - Family PracticePractitioner - Emergency Medicine 7214990852 Reassigns benefits to 4 organizations
Practice locations: Colorado City, TX

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

997 W Interstate 20
Colorado City, TX 79512-2685
Phone 32572885227590

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mitchell County Hospital District Family Medicine CurrentSince Oct 25, 2021 Accepting new patients
Mitchell County Hospital District CurrentSince Oct 25, 2021 Accepting new patients
Abk Emergency Physicians PLLC Emergency Medicine Past Accepting new patients
Ascension Seton Past Accepting new patients
Smithville Hospital Authority Past Accepting new patients

Locations

997 W Interstate 20
Colorado City, TX 79512
Phone (325) 728-3431

Interoperability endpoints

  • Direct secure messaging: jaddison@yourcarecommunity.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1629094552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 W INTERSTATE 20",
            "city": "COLORADO CITY",
            "state": "TX",
            "postal_code": "795123998",
            "telephone_number": "325-728-2693",
            "fax_number": "325-728-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 W INTERSTATE 20",
            "city": "COLORADO CITY",
            "state": "TX",
            "postal_code": "795122685",
            "telephone_number": "325-728-2693",
            "fax_number": "325-728-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "JOHN",
        "middle_name": "BRUCE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-03-07",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J1829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "J1829",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRUCE",
            "last_name": "ADDISON",
            "credential": "D.O.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Colorado City, TX

Sources for this page

Verify at the official NPI Registry.