Retina Institute of South Texas

Primary specialty

SpecialistTaxonomy code 174400000X

License

J4706 Issued in TX

Legal business name

RETINA INSTITUTE OF SOUTH TEXAS

Practice address

11651 Toepperwein Rd
Ste 201
Live Oak, TX 78233-3147

Phone

(210) 654-0400

Fax

(210) 654-0460

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wendall Bauman, M.D.NPI 1508082132

Title

Owner

Phone

(210) 654-0400

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Wendall Bauman, M.D.

  • Specialist
  • Live Oak, TX
  • NPI 1508082132
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1629196118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 PRIMROSE PL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782093832",
            "telephone_number": "210-654-0400",
            "fax_number": "210-654-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11651 TOEPPERWEIN RD",
            "address_2": "STE 201",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333147",
            "telephone_number": "210-654-0400",
            "fax_number": "210-654-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA INSTITUTE OF SOUTH TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "BAUMAN",
        "authorized_official_first_name": "WENDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-654-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "J4706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175842701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034567003",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Live Oak, TX
• Providers in Live Oak, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.