NPIMap

Organization Active NPI

Kerrville Med Express

Doing business as International Family Clinic

  • Internal Medicine Physician
  • South Padre Island, TX
National Provider Identifier
1639405855
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
J9579 Issued in TX
Legal business name
KERRVILLE MED EXPRESS
Doing business as
International Family Clinic
Practice address
2217 Padre Blvd
South Padre Island, TX 78597
Phone
(956) 761-4649
Fax
(866) 594-1025
NPI assigned
Oct 22, 2009
Last updated
Dec 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Authorized official

Name
Dr. Richard Bruce Debenedetto, M.D.NPI 1679549513
Title
Physician/Medical Director
Phone
(956) 761-4649

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X J9579 TX
Internal Medicine Physician 207R00000X J9579 TX Primary

Addresses

Primary practice location

2217 Padre Blvd
South Padre Island, TX 78597

Mailing address

2217 Padre Blvd
South Padre Island, TX 78597
Phone (956) 761-4649

Other identifiers 2

IdentifierTypeStateIssuer
8CE910OtherTXBCBSTX
113326621MedicaidTX

Other names 1

  • International Family Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

212 Sidney Baker St S
Kerrville, TX 78028
Phone (830) 257-0199

228 Washington St
Kerrville, TX 78028
Phone (830) 257-0199

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1639405855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2217 PADRE BLVD",
            "city": "SOUTH PADRE ISLAND",
            "state": "TX",
            "postal_code": "78597",
            "telephone_number": "956-761-4649",
            "fax_number": "866-594-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2217 PADRE BLVD",
            "city": "SOUTH PADRE ISLAND",
            "state": "TX",
            "postal_code": "78597",
            "telephone_number": "956-761-4649",
            "fax_number": "866-594-1025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRVILLE MED EXPRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "DEBENEDETTO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "PHYSICIAN/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "956-761-4649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "J9579",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J9579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8CE910",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113326621",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "International Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Padre Island, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; 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.