NPIMap

Organization Active NPI

San Jacinto Family Practice Education Foundation

  • Family Medicine Physician
  • Baytown, TX
National Provider Identifier
1902851728
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAN JACINTO FAMILY PRACTICE EDUCATION FOUNDATION
Practice address
4301 Garth Rd
Suite 400
Baytown, TX 77521-3153
Phone
(281) 420-8400
Fax
(281) 420-8480
NPI assigned
May 23, 2006
Last updated
Oct 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Authorized official

Name
Stacy D Pena
Title
Credentialing Coordinator
Phone
(281) 420-8502

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4301 Garth Rd
Suite 400
Baytown, TX 77521-3153

Mailing address

4301 Garth Rd
Suite 400
Baytown, TX 77521-3153
Phone (281) 420-8400

Other identifiers 2

IdentifierTypeStateIssuer
091752801MedicaidTX
091752802OtherTXEPSDT

National Provider Directory

National Provider Directory

Locations

4301 Garth Rd
Fl 4
Baytown, TX 77521
Phone (281) 420-8400

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1902851728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 GARTH RD",
            "address_2": "SUITE 400",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775213153",
            "telephone_number": "281-420-8400",
            "fax_number": "281-420-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 GARTH RD",
            "address_2": "SUITE 400",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775213153",
            "telephone_number": "281-420-8400",
            "fax_number": "281-420-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JACINTO FAMILY PRACTICE EDUCATION FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "281-420-8502"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091752801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EPSDT",
            "identifier": "091752802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baytown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.