NPIMap

Organization Active NPI

Southeast Texas Self-Management of Diabetes

  • Endocrinology, Diabetes & Metabolism Physician
  • Beaumont, TX
National Provider Identifier
1649646357
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
J4950 Issued in TX
Legal business name
SOUTHEAST TEXAS SELF-MANAGEMENT OF DIABETES
Practice address
3030 North St Ste 560
Beaumont, TX 77702-1424
Phone
(409) 835-9834
Fax
(409) 895-3547
NPI assigned
Aug 17, 2015
Last updated
Aug 17, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
ENDOCRINE CLINIC OF SOUTHEAST TEXASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Authorized official

Name
Robert C Hood, MDNPI 1053321539
Title
President
Phone
(409) 835-9834

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X J4950 TX Primary

Addresses

Primary practice location

3030 North St Ste 560
Beaumont, TX 77702-1424

Mailing address

3030 North St Ste 560
Beaumont, TX 77702-1424
Phone (409) 835-9834

Other identifiers 1

IdentifierTypeStateIssuer
085737702MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050608000568 TX Part B Supplier - Clinic/Group Practice 4688617848 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaumont, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Endocrine Clinic of SE TX2 organizations share this tax ID, including this one
Part of
Endocrine Clinic of SE TX

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3070 College St
Ste 403
Beaumont, TX 77701
Phone (409) 835-9834

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1649646357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 NORTH ST STE 560",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021424",
            "telephone_number": "409-835-9834",
            "fax_number": "409-895-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 NORTH ST STE 560",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021424",
            "telephone_number": "409-835-9834",
            "fax_number": "409-895-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST TEXAS SELF-MANAGEMENT OF DIABETES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENDOCRINE CLINIC OF SOUTHEAST TEXAS",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "HOOD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "409-835-9834",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "J4950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085737702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.