Jhonny Martin Bazan MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

JHONNY MARTIN BAZAN MD PA

Doing business as

San Martin de Porres Clinic

Practice address

1337 E Palma Vista Dr Ste a
Palmview, TX 78572-2055

Phone

(956) 519-9500

Fax

(956) 519-4549

NPI assigned

Dec 13, 2006

Last updated

Oct 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jhonny Martin Bazan, MDNPI 1760542807

Title

Owner MD/ Provider/ President

Phone

(956) 519-9500

Specialties & licenses 3

Addresses

Other identifiers 6

Other names 1

• San Martin de Porres Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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.

• Jhonny Martin Bazan, MD

  • Internal Medicine Physician
  • Palmview, TX
  • NPI 1760542807
  Medicare reassignment NPD Authorized official
• Alejandro Gonzalez, PA-C

  • Physician Assistant
  • La Joya, TX
  • NPI 1437838893
  NPD
• Elizabeth Jane Woods, DPT

  • Physical Therapist
  • Palmview, TX
  • NPI 1326346792
  NPD (past)

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729296000000",
    "number": "1710048756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 E PALMA VISTA DR STE A",
            "city": "PALMVIEW",
            "state": "TX",
            "postal_code": "785722055",
            "telephone_number": "956-519-9500",
            "fax_number": "956-514-9414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 E PALMA VISTA DR STE A",
            "city": "PALMVIEW",
            "state": "TX",
            "postal_code": "785722055",
            "telephone_number": "956-519-9500",
            "fax_number": "956-519-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JHONNY MARTIN BAZAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A",
        "authorized_official_last_name": "BAZAN",
        "authorized_official_first_name": "JHONNY",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER MD/ PROVIDER/ PRESIDENT",
        "authorized_official_telephone_number": "956-519-9500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "K1355",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": "K1355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041729705",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041729703",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173560701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CASE MANAGEMENT",
            "identifier": "220041063",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0066NL",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1912169459",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Martin de Porres Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Palmview, TX
• Providers in Palmview, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2024; 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.