NPIMap

Individual provider Active NPI

Richard Bruce Debenedetto, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • South Padre Island, TX
National Provider Identifier
1679549513
Registry record updated Oct 3, 2013
On this page

OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • Section 1128a(4) exclusion effective Aug 20, 2015.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
J9579 Issued in TX
Practice address
2217 Padre Blvd
South Padre Island, TX 78597
Phone
(956) 761-4649
Fax
(866) 594-1025
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Specialties & licenses 2

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

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 3

IdentifierTypeStateIssuer
8CE910OtherTXBCBS
113326621MedicaidTX
8CE910OtherTXBCBSTX

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Hospital, LTD Past Accepting new patients
Texas Emergency Room Services PA Past Accepting new patients
Kerrville Eye Center PA Past Accepting new patients
Glen Rose Medical Foundation Inc. Past Accepting new patients
Family Allergy & Asthma Center PA Past Accepting new patients
Palm Valley Emergency Physicians Specialists PLLC Emergency Medical Services Past Accepting new patients
Glen Rose Medical Foundation Past Accepting new patients
JK Sun Valley Healthcare Associates PA Past Accepting new patients
Boone Emergency Physicians PLLC Past Accepting new patients

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1679549513",
    "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": {
        "last_name": "DEBENEDETTO",
        "first_name": "RICHARD",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "J9579",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J9579",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8CE910",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113326621",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8CE910",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Padre Island, TX

Sources for this page

Verify at the official NPI Registry.