NPIMap

Organization Active NPI

Buckner Retirement Services, Inc.

Doing business as Buckner Villa Siesta Home

  • Assisted Living Facility
  • Austin, TX
National Provider Identifier
1841301868
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
BUCKNER RETIREMENT SERVICES, INC.
Doing business as
Buckner Villa Siesta Home
Practice address
11110 Tom Adams Dr
Austin, TX 78753-3354
Phone
(512) 836-1515
Fax
(512) 836-7627
NPI assigned
Aug 31, 2006
Last updated
Aug 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Authorized official

Name
Jessica Moore
Title
MGR of Administration & Contract
Phone
(214) 758-8136

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Rehabilitation Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0019X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Assisted Living Facility 310400000X Primary
Skilled Nursing Facility 314000000X 113372 TX

Addresses

Primary practice location

11110 Tom Adams Dr
Austin, TX 78753-3354

Mailing address

12377 Merit Dr Ste 900
Dallas, TX 75251-3102
Phone (214) 758-8000

Other names 1

  • Buckner Villa Siesta Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240910000294 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5193637007 Receives reassigned benefits from 8 practitioners
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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1005 E Braker Ln
Ste 1
Austin, TX 78753
Phone (512) 873-8145

1812 Centre Creek Dr
Ste 240
Austin, TX 78754
Phone (512) 873-8145

700 N Pearl St
Ste 1200
Dallas, TX 75201

11111 Katy Fwy
Ste 620
Houston, TX 77079
Phone (281) 493-6800

3100 S Gessner Rd
Ste 109
Houston, TX 77063
Phone (281) 493-6800

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Calder WoodsBeaumont, TX, CCN 676109 Skilled nursing facility Adp of the SNF
Direct Ownership Interest (100%)		 Jul 9, 2025
Jul 1, 2000
Buckner Westminster PlaceLongview, TX, CCN 676167 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Trustee of the SNF
Adp of the SNF		 Jan 1, 1996
Jan 1, 1996
Jul 13, 2025
Parkway PlaceHouston, TX, CCN 675777 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Jan 1, 1998
Jul 14, 2025
Jan 1, 1998
The Stayton at Museum WayFort Worth, TX, CCN 676305 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jun 1, 2024
Jun 1, 2024
Jun 1, 2024

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754006400000",
    "number": "1841301868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12377 MERIT DR STE 900",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752513102",
            "telephone_number": "214-758-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 TOM ADAMS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787533354",
            "telephone_number": "512-836-1515",
            "fax_number": "512-836-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKNER RETIREMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "MGR OF ADMINISTRATION & CONTRACT",
        "authorized_official_telephone_number": "214-758-8136"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "113372",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buckner Villa Siesta Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.