Individual provider Active NPI

Paul Berman, M.D.

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1639144504
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L2137 Issued in TX
Practice address
12222 Vance Jackson Rd
Suite 1322
San Antonio, TX 78230-5936
Phone
(210) 691-0800
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X L2137 TX
Pediatrics Physician 208000000X L2137 TX Primary

Addresses

Primary practice location

12222 Vance Jackson Rd
Suite 1322
San Antonio, TX 78230-5936

Mailing address

12222 Vance Jackson Rd
Suite 1322
San Antonio, TX 78230-5936
Phone (210) 691-0800

Other identifiers 2

IdentifierTypeStateIssuer
147286201MedicaidTX
8C0452OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L2137TXMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1639144504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12222 VANCE JACKSON RD",
            "address_2": "SUITE 1322",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782305936",
            "telephone_number": "210-691-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12222 VANCE JACKSON RD",
            "address_2": "SUITE 1322",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782305936",
            "telephone_number": "210-691-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMAN",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L2137",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L2137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147286201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8C0452",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.