NPIMap

Organization Active NPI

College Street Medical Group, P.L.L.C.

  • Family Medicine Physician
  • Beaumont, TX
National Provider Identifier
1912233289
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLLEGE STREET MEDICAL GROUP, P.L.L.C.
Practice address
5755 College St
Beaumont, TX 77707-3518
Phone
(409) 840-9300
Fax
(409) 842-4960
NPI assigned
Oct 21, 2009
Last updated
Apr 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Dr. Bodre RisingNPI 1447280748
Title
Provider/Owner
Phone
(409) 840-9300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

5755 College St
Beaumont, TX 77707-3518

Mailing address

5755 College St
Beaumont, TX 77707-3518
Phone (409) 840-9300

National Provider Directory

National Provider Directory

Locations

5755 College St
#B
Beaumont, TX 77707
Phone (409) 840-9300

Practitioners & affiliated clinicians

Practitioners 4

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": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1912233289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5755 COLLEGE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777073518",
            "telephone_number": "409-840-9300",
            "fax_number": "409-842-4960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 COLLEGE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777073518",
            "telephone_number": "409-840-9300",
            "fax_number": "409-842-4960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE STREET MEDICAL GROUP, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "RISING",
        "authorized_official_first_name": "BODRE",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "409-840-9300",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

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