| Centric Physicians Group P.l.l.c. | |
|
540 Oak Centre Dr Ste 260 San Antonio TX 78258-4767 | |
| (830) 267-4575 | |
| Not Available |
| Full Name | Centric Physicians Group P.l.l.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 540 Oak Centre Dr Ste 260, San Antonio, Texas |
| Authorized Official Name and Position | Scott Steele (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2103153305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centric Physicians Group P.l.l.c. 113 Pleasant Valley Dr Ste 210 Boerne TX 78006-5683 Ph: (830) 267-4575 | Centric Physicians Group P.l.l.c. 540 Oak Centre Dr Ste 260 San Antonio TX 78258-4767 Ph: (830) 267-4575 |
| NPI Number | 1073907184 |
|---|---|
| Provider Enumeration Date | 03/26/2015 |
| Last Update Date | 03/31/2020 |
| Medicare PECOS PAC ID | 1951614726 |
|---|---|
| Medicare Enrollment ID | O20150722005727 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073907184 | NPI | - | NPPES |
| 3519357-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | L1053 (Texas) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | David G Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689609125 PECOS PAC ID: 8820992712 Enrollment ID: I20031121000697 |
| Provider Name | Rosaria Taimouri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306952296 PECOS PAC ID: 2466435300 Enrollment ID: I20040610001475 |
| Provider Name | Jennifer S Retzloff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649493511 PECOS PAC ID: 1052370350 Enrollment ID: I20041004000307 |
| Provider Name | Milton Shaw |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1346203007 PECOS PAC ID: 3678535879 Enrollment ID: I20041030000113 |
| Provider Name | Laura Givens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902957046 PECOS PAC ID: 0345290847 Enrollment ID: I20050122000161 |
| Provider Name | Kathleen L Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477577567 PECOS PAC ID: 6709882723 Enrollment ID: I20061016000304 |
| Provider Name | Douglas W Sander |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568567881 PECOS PAC ID: 1850393463 Enrollment ID: I20070212000294 |
| Provider Name | Tracey Martinez-mendez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154498285 PECOS PAC ID: 0648370973 Enrollment ID: I20070716000147 |
| Provider Name | Melanie D Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255529905 PECOS PAC ID: 0244310068 Enrollment ID: I20080107000534 |
| Provider Name | Jay Dale Akin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043347222 PECOS PAC ID: 5698874071 Enrollment ID: I20090114000244 |
| Provider Name | Fonshay Latrice Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588814263 PECOS PAC ID: 0840354833 Enrollment ID: I20090206000188 |
| Provider Name | Caridad M Rebollar |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1073598520 PECOS PAC ID: 3072422823 Enrollment ID: I20090902000221 |
| Provider Name | Peter P Acosta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083637888 PECOS PAC ID: 1951457423 Enrollment ID: I20090924000528 |
| Provider Name | Nissa B Shakocius |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821244658 PECOS PAC ID: 9638212251 Enrollment ID: I20100204000658 |
| Provider Name | Theresa Lynn Lyons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578734133 PECOS PAC ID: 3072647932 Enrollment ID: I20100813000233 |
| Provider Name | Don N Murrmann |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821027038 PECOS PAC ID: 2567435811 Enrollment ID: I20110318000282 |
| Provider Name | Virginia Barlow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194768200 PECOS PAC ID: 7810066867 Enrollment ID: I20110412000804 |
| Provider Name | Jesus Aranda-cano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003106543 PECOS PAC ID: 5496932469 Enrollment ID: I20110601000194 |
| Provider Name | Barbara V Wise |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578586541 PECOS PAC ID: 8022110592 Enrollment ID: I20110615000216 |
| Provider Name | Gregory J Brogden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659674760 PECOS PAC ID: 7719156405 Enrollment ID: I20110815000635 |
| Provider Name | Amanda S Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023367505 PECOS PAC ID: 6709035306 Enrollment ID: I20120925000446 |
| Provider Name | Zulfiqar A Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528168788 PECOS PAC ID: 6709931793 Enrollment ID: I20121106000434 |
| Provider Name | Tracey Cawthorn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982850665 PECOS PAC ID: 1658516588 Enrollment ID: I20130326000248 |
| Provider Name | Manuel R Emperador |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649682790 PECOS PAC ID: 7416179296 Enrollment ID: I20141111001267 |
| Provider Name | Kristin Dillon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013321686 PECOS PAC ID: 0042535478 Enrollment ID: I20150206000295 |
| Provider Name | Lourdes Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659773869 PECOS PAC ID: 5092030965 Enrollment ID: I20150217001962 |
| Provider Name | Michael G Malinas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356439319 PECOS PAC ID: 5496072464 Enrollment ID: I20150401000306 |
| Provider Name | Crystal Villanueva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366828543 PECOS PAC ID: 1759691124 Enrollment ID: I20151116000451 |
| Provider Name | Helen Tellegen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932573920 PECOS PAC ID: 9537462205 Enrollment ID: I20160129001976 |
| Provider Name | Melinda K Hoffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164415006 PECOS PAC ID: 4082701487 Enrollment ID: I20160617000258 |
| Provider Name | Alikia Abner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750834826 PECOS PAC ID: 5890921787 Enrollment ID: I20160929002035 |
| Provider Name | Efrem Darron Dehughes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679088876 PECOS PAC ID: 8921366956 Enrollment ID: I20171221001624 |
| Provider Name | Gail W Hubbard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235515867 PECOS PAC ID: 7517229172 Enrollment ID: I20180319000981 |
| Provider Name | Sarah Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851821789 PECOS PAC ID: 7719241959 Enrollment ID: I20180516000146 |
| Provider Name | Katrina L Hallmark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285708420 PECOS PAC ID: 7911939517 Enrollment ID: I20190125000775 |
| Provider Name | Kayla L Himphayvanh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578036026 PECOS PAC ID: 3375873953 Enrollment ID: I20190924003252 |
| Provider Name | Kathleen M Jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972072262 PECOS PAC ID: 2466885876 Enrollment ID: I20191125001952 |
| Provider Name | Victor Manuel Armendariz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679124333 PECOS PAC ID: 8527491935 Enrollment ID: I20191125002052 |
| Provider Name | Dominique Rasso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578114112 PECOS PAC ID: 7618301573 Enrollment ID: I20191231000472 |
| Provider Name | Jessica Andrea Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588204077 PECOS PAC ID: 2466714845 Enrollment ID: I20200304002439 |
| Provider Name | Linda D Reid-bonnema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336341429 PECOS PAC ID: 2062841331 Enrollment ID: I20200408000347 |
| Provider Name | Madisen Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689155764 PECOS PAC ID: 0547508525 Enrollment ID: I20201123003395 |
| Provider Name | Nichol Lynn Burch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285398255 PECOS PAC ID: 2062801509 Enrollment ID: I20211122003078 |
| Provider Name | Angela Marie Chamberlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194483446 PECOS PAC ID: 0446642706 Enrollment ID: I20220118001037 |
| Provider Name | Derek Jason Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598411779 PECOS PAC ID: 8628465226 Enrollment ID: I20220429000885 |
| Provider Name | Marta Joanna Cacace-mata |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013621390 PECOS PAC ID: 4587035696 Enrollment ID: I20230128000432 |
| Provider Name | Anthony Steven Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376326884 PECOS PAC ID: 1557712031 Enrollment ID: I20240109002716 |
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