NPIMap

Organization Active NPI

Privia Medical Group Gulf Coast, PLLC

Doing business as Shine Foot and Ankle Center, Privia Medical Group Gulf Coast, PLLC

  • Podiatrist
  • Austin, TX
National Provider Identifier
1689267783
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
PRIVIA MEDICAL GROUP GULF COAST, PLLC
Doing business as
Shine Foot and Ankle Center, Privia Medical Group Gulf Coast, PLLC
Practice address
11614 FM 2244 Rd Ste 150
Austin, TX 78738-5471
Phone
(512) 399-5711
Fax
(512) 339-5707
NPI assigned
Feb 19, 2021
Last updated
Feb 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Authorized official

Name
Barbara Jordan
Title
Associate VP, Revenue Cycle
Phone
(713) 512-7613

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

11614 FM 2244 Rd Ste 150
Austin, TX 78738-5471

Mailing address

1200 Binz St Ste 1490
Houston, TX 77004-6946
Phone (713) 512-7700

Other names 1

  • Shine Foot and Ankle Center, Privia Medical Group Gulf Coast, PLLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210402000747 TX DME Supplier - Physician - Podiatry 4688999022 Practice locations: Austin, TX

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Southwest Womens HLTH Allia21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1689267783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 BINZ ST STE 1490",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770046946",
            "telephone_number": "713-512-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11614 FM 2244 RD STE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787385471",
            "telephone_number": "512-399-5711",
            "fax_number": "512-339-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP GULF COAST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "ASSOCIATE VP, REVENUE CYCLE",
        "authorized_official_telephone_number": "713-512-7613"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shine Foot and Ankle Center, Privia Medical Group Gulf Coast, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.