Active NPI
Kunjamma Sebastian, MD
- Pediatrics Physician
- Bay City, TX
National Provider Identifier
1821073248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G1772
- Practice address
- 1410 Avenue F
Bay City, TX 77414-3418 - Phone
- (979) 245-1305
- Fax
- (979) 244-4442
- NPI assigned
- Dec 8, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G1772 | TX | Primary |
Addresses
Primary practice location
1410 Avenue F
Bay City, TX 77414-3418
Mailing address
101 Avenue F N
Bay City, TX 77414-3167
Phone (979) 245-2008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1204703 03 | Medicaid | TX |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170718003444 | TX | Practitioner - Pediatric Medicine | 8123398575 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G1772 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matagorda Episcopal Health Outreach Program | Past | Accepting new patients |
Interoperability endpoints
- ksebastian@mehop.directbygreenway.com
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Palacios, TX
- NPI 1467009092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498003200000",
"number": "1821073248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 AVENUE F N",
"city": "BAY CITY",
"state": "TX",
"postal_code": "774143167",
"telephone_number": "979-245-2008",
"fax_number": "979-217-8829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 AVENUE F",
"city": "BAY CITY",
"state": "TX",
"postal_code": "774143418",
"telephone_number": "979-245-1305",
"fax_number": "979-244-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEBASTIAN",
"first_name": "KUNJAMMA",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-08",
"last_updated": "2017-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "G1772",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1204703 03",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bay City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.