NPIMap

Organization Active NPI

Specialty Clinic Medical Group, PLLC

Doing business as Specialty Clinic of Austin

  • Psychiatry Physician
  • Austin, TX
National Provider Identifier
1629409909
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SPECIALTY CLINIC MEDICAL GROUP, PLLC
Doing business as
Specialty Clinic of Austin
Practice address
2217 Park Bend Dr Ste 300
Austin, TX 78758-5674
Phone
(512) 382-1933
Fax
(512) 777-4949
NPI assigned
Dec 11, 2013
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Dr. Divyansu Patel, M.D.NPI 1710178702
Title
Manager
Phone
(512) 382-1933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X TX
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2217 Park Bend Dr Ste 300
Austin, TX 78758-5674

Mailing address

2217 Park Bend Dr Ste 300
Austin, TX 78758-5674
Phone (512) 382-1933

Other names 1

  • Specialty Clinic of Austin Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210721003537 TX Part B Supplier - Clinic/Group Practice 4082017512 Receives reassigned benefits from 34 practitioners
Practice locations: Austin, TX

National Provider Directory

National Provider Directory

Locations

2217 Park Bend Dr
Austin, TX 78758
Phone (916) 746-2343

4515 Seton Center Pkwy
Ste 175
Austin, TX 78759
Phone (512) 256-6979

Practitioners & affiliated clinicians

Practitioners 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1629409909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2217 PARK BEND DR STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787585674",
            "telephone_number": "512-382-1933",
            "fax_number": "512-777-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2217 PARK BEND DR STE 300",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787585674",
            "telephone_number": "512-382-1933",
            "fax_number": "512-777-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY CLINIC MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "DIVYANSU",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "512-382-1933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specialty Clinic of Austin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Specialty Clinic of Austin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; 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.