BLACKHAWK PHYSICIAN GROUP (NPI# 1609021765) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609021765 |
| Entity Type | Organization |
| Organization Name | BLACKHAWK PHYSICIAN GROUP |
| Practice Address |
1700 Brazos Ave Rockdale TX 76567-2517 |
| Mailing Address |
6500 River Place Blvd Building 1, Suite 350 Austin TX 78730-1119 |
| Practice Telephone | 5124464502 |
| Mailing Telephone | 5126813440 |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2008-11-17 |
| Authorized Official Name | TODD BIEDERMAN (PRESIDENT/CEO) |
| Authorized Official Telephone | 5126813440 |
| Is Organization Subpart | Y |
| Parent Organization Name | BLACKHAWK HEALTHCARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Street Address |
1700 BRAZOS AVE |
| City | ROCKDALE |
| State | TX |
| Zip Code | 76567-2517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487697280 | Mary L Grose | Nurse Practitioner | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2006-06-13 |
| 1679068795 | Terri Denise Buchanan | Nurse Practitioner | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2018-07-01 |
| 1134660277 | Laurel Herzog | Physical Therapist | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2017-03-08 |
| 1013325927 | Neile Elaine Briden | Nurse Practitioner | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2014-07-24 |
| 1912341579 | Michael Sonier Jr. | Family Medicine | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2013-04-24 |
| 1871822981 | Ann Nicole Abrams | Nurse Practitioner | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2009-12-18 |
| 1609007756 | Rockdale Blackhawk LLC | Clinic/Center | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2009-08-06 |
| 1558513788 | Ramona Butala | Occupational Therapist | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2008-10-21 |
| 1811156730 | Ikechukwu John Obih | Psychiatry & Neurology | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2008-06-05 |
| 1144490103 | Rockdale Hospital District | Clinic/Center | 1700 Brazos Ave, Rockdale, TX 76567-2517 | 2008-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912372459 | Rockdale Snf LLC | Skilled Nursing Facility | 1350 W Us Highway 79, Rockdale, TX 76567 | 2015-12-09 |
| 1295125391 | Melinda Richards Catching | Speech-Language Pathologist | 123 West Cameron Ave., Rockdale, TX 76567 | 2015-01-27 |
| 1285911123 | Rockdale Blackhawk, LLC | Clinic/Center | 1700 Brazos, Suite A, B and C, Rockdale, TX 76567 | 2011-11-07 |
| 1447206669 | Christen J Leblanc | Emergency Medicine | 1700 Brazos Ave., Rockdale, TX 76567 | 2006-05-26 |
| 1316373616 | Kristi Lynn Estrada | Nurse Practitioner | 1700 Brazos, Rockdale, TX 76567 | 2013-09-18 |
| 1205309028 | Bradford Ingram | Licensed Vocational Nurse | 1800 Sager Rd, Rockdale, TX 76567-2060 | 2019-01-03 |
| 1932409786 | Malda Mayo Burns | Counselor | 1503 Skyles Rd, Rockdale, TX 76567-2074 | 2010-10-27 |
| 1740580356 | Burns Professional Services LLC | Community/Behavioral Health | 1503 Skyles Rd, Rockdale, TX 76567-2074 | 2010-10-28 |
| 1639259179 | Arboretum Health Care, Inc. | Skilled Nursing Facility | 700 Dyer St, Rockdale, TX 76567-2208 | 2006-10-17 |
| 1740559640 | Alison Parker | Speech-Language Pathologist | 700 Dyer St, Rockdale, TX 76567-2208 | 2011-12-21 |
| Find all providers in zip 76567 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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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.