Federico Valderrama-Bazan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E3488 Issued in TX

Practice address

810 Hospital Dr
Suite 320
Beaumont, TX 77701-4600

Phone

(409) 839-4757

Fax

(409) 839-4294

NPI assigned

Aug 23, 2006

Last updated

Sep 28, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Texas Alliance Medical Group, PA

  dba Doctors Clinic Houston

  • Family Medicine Physician
  • Houston, TX
  • NPI 1861446304
  Medicare reassignment
• Federico Valderrama-Bazan, M.D.,P.a.

  • Family Medicine Physician
  • Beaumont, TX
  • NPI 1366517088
  Authorized official Same address or phone
• Baptist Physician Network

  • Specialist
  • Beaumont, TX
  • NPI 1558485532
  NPD (past)
• Preventive Medicine of Southeast Texas, LLP

  • Family Medicine Physician
  • Beaumont, TX
  • NPI 1013928290
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1851408496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 HOSPITAL DR",
            "address_2": "SUITE 320",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014600",
            "telephone_number": "409-839-4757",
            "fax_number": "409-839-4294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 HOSPITAL DR",
            "address_2": "SUITE 320",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014600",
            "telephone_number": "409-839-4757",
            "fax_number": "409-839-4294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDERRAMA-BAZAN",
        "first_name": "FEDERICO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E3488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123414807",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172224101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Utmb Regional Maternal and Child Health Program
• Utmb Regional Maternal and Child Health Program (UTMB RMCHP-Beaumont)
• VA Outpatiient Clinic
• Kelli W Vacek, MA, RD, LD
• Seyede Maryam Vahedi
• Britt Jerome Valenta, PHARMD
• Valentine Counseling
• Leslie Valentine, LPC-A
• Crissa Jean Vallery, LPC
• Avery Valls, DDS

• Family Medicine Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; 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.

Verify at the official NPI Registry.