Individual provider Active NPI

Antionette Grove, NURSE PRACTITIONER

  • Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1730903022
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1179901 Issued in TX
Practice address
540 Madison Oak Dr Ste 310
San Antonio, TX 78258-3921
Phone
(210) 657-2100
NPI assigned
Nov 13, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 1179901 TX
Nurse Practitioner 363L00000X 1179901 TX Primary
Acute Care Nurse Practitioner 363LA2100X 1179901 TX

Addresses

Primary practice location

540 Madison Oak Dr Ste 310
San Antonio, TX 78258-3921

Mailing address

540 Madison Oak Dr Ste 310
San Antonio, TX 78258-3921
Phone (210) 657-2100

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241216004011 TX Practitioner - Nurse Practitioner 9032646922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
BHS Physicians Network, IncGroup PAC ID 7315019593, 702 clinicians

Practice addresses (Care Compare)

540 Madison Oak Dr
Suite 310
San Antonio, TX 78258-3921
Phone (210) 657-2100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1179901TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
BHS Physicians Network, Inc CurrentSince Dec 11, 2024 Accepting new patients
BHS Physicians Network, Inc CurrentSince Dec 11, 2024 Accepting new patients
BHS Specialty Network Inc PastSince Nov 17, 2024 Accepting new patients

Locations

8715 Village Dr
San Antonio, TX 78217
Phone (210) 297-2550

540 Madison Oak Dr
Ste 310
San Antonio, TX 78258

3903 Wiseman Blvd
San Antonio, TX 78251
Phone (210) 681-0126

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1730903022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 MADISON OAK DR STE 310",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583921",
            "telephone_number": "210-657-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MADISON OAK DR STE 310",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583921",
            "telephone_number": "210-657-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVE",
        "first_name": "ANTIONETTE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-13",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1179901",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1179901",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1179901",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.