PEDIATRIC SURGICAL SUBSPECIALISTS (NPI# 1184815227) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184815227 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC SURGICAL SUBSPECIALISTS |
| Other Organization Name | PEDIATRIC NEUROSURGERY CENTER OF CENTRAL TEXAS |
| Practice Address |
1301 Barbara Jordan Blvd Ste 307 Austin TX 78723-3080 |
| Practice Telephone | 5123249999 |
| Practice Fax Number | 5123240643 |
| Mailing Telephone | 5123249999 |
| Mailing Fax Number | 5123240643 |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2008-06-27 |
| Authorized Official Name | ROBERT TODD MAXSON (CEO) |
| Authorized Official Telephone | 5123248068 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | MEDICARE PTAN | 00Y420 | 01 |
| Other Name | Type Code |
|---|---|
| Pediatric Neurosurgery Center of Central Texas | Doing Business As Name - Organization |
| Street Address |
1301 BARBARA JORDAN BLVD STE 307 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78723-3080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811975816 | Adriana C Da Silveira | Dentist | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2006-01-09 |
| 1427331842 | Jennifer Gayle Farley | Nurse Practitioner | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2011-09-21 |
| 1962640938 | Chelsea Ann Combs | Physician Assistant | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3077 | 2009-01-29 |
| 1053433102 | Jodie M Roth | Nurse Practitioner | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2007-04-06 |
| 1124145255 | Raymond Jackson Harshbarger IIi | Plastic Surgery | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2007-03-23 |
| 1841342078 | Emily Hopper | Nurse Practitioner | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2007-01-17 |
| 1336236850 | Patricia Anne Aronin | Neurological Surgery | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2006-10-06 |
| 1326060161 | Timothy Merrill George | Neurological Surgery | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2006-07-24 |
| 1801820170 | Maureen R Nelson | Physical Medicine & Rehabilitation | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2006-07-10 |
| 1346271285 | Terra Michelle Riley | Physician Assistant | 1301 Barbara Jordan Blvd Ste 307, Austin, TX 78723-3080 | 2006-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144787318 | Bridget Wilson | Counselor | 6448 East Hwy 290, Suite F108, Austin, TX 78723 | 2019-02-25 |
| 1700378999 | Andrew Christopher Shanks | Counselor | 2132 Antone St, Austin, TX 78723 | 2018-06-04 |
| 1316434236 | Yasaman Ahmadieh | Pediatrics | 4900 Mueller Boulevard, Suite 3s.066c, Austin, TX 78723 | 2018-04-16 |
| 1215433354 | Erika Senai Ramirez | Nurse Practitioner | 6900 Ed Bluestein Blvd, Austin, TX 78723 | 2018-04-05 |
| 1518477645 | Brigitte Tyree | Registered Nurse | 2237 Zach Scott St, Austin, TX 78723 | 2017-10-03 |
| 1942735980 | Ila Sehgal | Pediatrics | 4900 Mueller Blvd, Ste 3s.066c, Dell Children's Medical Center, Austin, TX 78723 | 2017-04-27 |
| 1851825194 | Terry Blackmon | Behavioral Analyst | 2021 Zach Scott St, Austin, TX 78723 | 2017-04-13 |
| 1114337961 | Cassandra Sorensen | Home Health | 3001 Maplelawn Circle, Austin, TX 78723 | 2014-05-02 |
| 1336569052 | Ricky C Mehta | Internal Medicine | 6210 E Hwy 290 Ste 420, Austin, TX 78723 | 2014-04-21 |
| 1356761373 | Peter Caldwell Gilbreath | Pediatrics | 4900 Mueller Boulevard, Suite 3s.066c, Dell Children's Medical Center, Austin, TX 78723 | 2014-04-17 |
| Find all providers in zip 78723 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497222400 | Justin K Sandefur | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2018-10-28 |
| 1710366893 | Sai Krishna Surapa Raju | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2015-05-22 |
| 1639513971 | Kelly Bora | Pediatrics | 12221 N Mopac Expy, Austin, TX 78758 | 2013-04-17 |
| 1154603512 | Kyle Scott Miller | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2011-09-12 |
| 1477849313 | Milton Meadows | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2011-06-20 |
| 1295038479 | Meghan Lane | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2010-12-10 |
| 1518019520 | Taj M Khan | Pediatrics | 12221 N Mopac Expy, Austin, TX 78758-2401 | 2007-01-18 |
| 1427138833 | Tandy Alice Mellard | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2006-10-17 |
| 1073615977 | Kyle Lieppman | Pediatrics | 4900 Mueller Blvd, Austin, TX 78723-3079 | 2006-09-01 |
| 1184731788 | Alexandra Wilson | Pediatrics | 4900 Mueller Blvd, C/o Dell Children's Medical Center, Austin, TX 78723-3079 | 2006-08-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.