NPIMap

Organization Active NPI

Central Texas Heart Center

  • Cardiovascular Disease Physician
  • Bryan, TX
National Provider Identifier
1871666271
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CENTRAL TEXAS HEART CENTER
Practice address
2700 E 29TH Street
Suite 220
Bryan, TX 77802-2586
Phone
(979) 774-4008
Fax
(979) 774-7893
NPI assigned
Nov 16, 2006
Last updated
Apr 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Kennon D Wigley, MDNPI 1215904495
Title
Physician
Phone
(979) 774-4008

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

2700 E 29TH Street
Suite 220
Bryan, TX 77802-2586

Mailing address

2700 E 29TH St
Suite 220
Bryan, TX 77802-2531
Phone (979) 774-4008

Other identifiers 2

IdentifierTypeStateIssuer
082010201MedicaidTX
CD6802OtherRAILROAD MEDICARE

Other names 1

  • Prof Association Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040617001706 TX Part B Supplier - Clinic/Group Practice 6901880863 Receives reassigned benefits from 10 practitioners
Practice locations: Bryan, TX

National Provider Directory

National Provider Directory

Locations

2700 E 29th St
Ste 220
Bryan, TX 77802
Phone (409) 774-4008

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIIEBD

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1871666271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 E 29TH ST",
            "address_2": "SUITE 220",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022531",
            "telephone_number": "979-774-4008",
            "fax_number": "979-774-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 E 29TH STREET",
            "address_2": "SUITE 220",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022586",
            "telephone_number": "979-774-4008",
            "fax_number": "979-774-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL TEXAS HEART CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "WIGLEY",
        "authorized_official_first_name": "KENNON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "979-774-4008",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082010201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD6802",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prof Association",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.