Brett Deatherage, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

T50988 Issued in TX

Practice address

5103 Kyle Center Dr Ste 108
Kyle, TX 78640-6164

Phone

(877) 324-3310

NPI assigned

Jun 7, 2016

Last updated

Jun 29, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Diagnostic Radiology

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Seton Family of DoctorsGroup PAC ID 0941333280, 785 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brett.deatherage.2@8363.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Seton Family of Doctors

  • Neurological Surgery Physician
  • Austin, TX
  • NPI 1588997233

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Seton Family of Doctors

  dba One Medical Group of Texas

  • Family Medicine Physician
  • Austin, TX
  • NPI 1225644065

  Internal Medicine

  NPD
• Seton Family of Doctors

  dba Ascension Texas Imaging

  • Radiology Clinic/Center
  • Austin, TX
  • NPI 1275290694
  NPD
• Seton Family of Doctors

  dba Ascension Texas Imaging

  • Radiology Clinic/Center
  • Kyle, TX
  • NPI 1962025148
  NPD
• South Austin Health Imaging LLC

  • Radiology Clinic/Center
  • Austin, TX
  • NPI 1629123765
  NPD

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1669821070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5103 KYLE CENTER DR STE 108",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406164",
            "telephone_number": "877-324-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5103 KYLE CENTER DR STE 108",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406164",
            "telephone_number": "877-324-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "BRETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "T50988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS-IN-TRAINING PERMIT",
            "identifier": "10057590",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Foronda De Lota, MD
• Deaf Advocates of America
• Danielle Marie Dean, M.S., CCC-SLP
• Megan Dean
• Robin Corina Dean, PT
• Dekow Dental, PLLC (Bravo Family Dentistry)
• Matthew Dekow, DMD
• Benita Deleon-Hernandez, LCSW
• Elyse Deleon, BCBA
• Felicia R Delgado, RBT

• Diagnostic Radiology Physician in Kyle, TX
• Providers in Kyle, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.