Individual provider Active NPI

Ross Eltidge Hairgrove, MD

  • Sports Medicine (Family Medicine) Physician
  • Kyle, TX
National Provider Identifier
1720427016
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
Q4760 Issued in TX
Practice address
4100 Everett Dr Ste 400
Kyle, TX 78640-6147
Phone
(512) 295-1333
Fax
(512) 406-7327
NPI assigned
Jun 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X Q4760 TX Primary

Addresses

Primary practice location

4100 Everett Dr Ste 400
Kyle, TX 78640-6147

Mailing address

6210 E Hwy 290
Austin, TX 78723-1142
Phone (512) 483-9596

Other identifiers 1

IdentifierTypeStateIssuer
348622703MedicaidTX

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150819007923 TX Practitioner - Sports MedicinePractitioner - Family Practice 9830404854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
University of Texas Medical School at San Antonio, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Austin Regional Clinic PAGroup PAC ID 3072507789, 398 clinicians

Practice addresses (Care Compare)

151 Exchange Blvd
500 Arc Hutto
Hutto, TX 78634-5381
Phone (512) 846-1244

4100 Everett
400 Arc Kyle
Kyle, TX 78640-6147
Phone (512) 295-1333

6835 Austin Ctr Blvd
Austin, TX 78731-3166
Phone (512) 346-6611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Regional Clinic, PA CurrentSince Oct 12, 2017 Accepting new patients
Austin Regional Clinic, PA CurrentSince Oct 12, 2017 Accepting new patients
Seton Hospitalist Service Past Accepting new patients

Locations

6210 E Highway 290
Austin, TX 78723

6835 Austin Center Blvd
Austin, TX 78731
Phone (512) 231-5210

4515 Seton Center Pkwy
Ste 215
Austin, TX 78759
Phone (512) 338-3802

151 Exchange Blvd
Ste 500
Hutto, TX 78634
Phone (512) 846-1244

4100 Everett
Ste 400
Kyle, TX 78640
Phone (512) 295-1333

Interoperability endpoints

  • Direct secure messaging: rhairgrove19788@arcmd.direct-ci.com

Organizations & group practices 3

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1720427016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 E HWY 290",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231142",
            "telephone_number": "512-483-9596",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 EVERETT DR STE 400",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406147",
            "telephone_number": "512-295-1333",
            "fax_number": "512-406-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIRGROVE",
        "first_name": "ROSS",
        "middle_name": "ELTIDGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "Q4760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348622703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, TX

Sources for this page

Verify at the official NPI Registry.