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2900 E 29th St Ste 200 Bryan TX 77802-2623 | |
| (979) 776-8440 | |
| (877) 601-5854 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2900 E 29th St Ste 200, Bryan, Texas |
| Authorized Official Name and Position | Robin Fuller (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9794360398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2900 E 29th St Ste 100 Bryan TX 77802-2623 Ph: (979) 436-0501 | 2900 E 29th St Ste 200 Bryan TX 77802-2623 Ph: (979) 776-8440 |
| NPI Number | 1063699312 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 07/31/2024 |
| Medicare PECOS PAC ID | 8224008644 |
|---|---|
| Medicare Enrollment ID | O20040802001578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063699312 | NPI | - | NPPES |
| 198523601 | Medicaid | TX |
| Provider Name | Susan G Roberman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982635348 PECOS PAC ID: 6800793340 Enrollment ID: I20031215000238 |
| Provider Name | David B Vaughan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124027792 PECOS PAC ID: 0840289021 Enrollment ID: I20040622001017 |
| Provider Name | Russell B Bacak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184705741 PECOS PAC ID: 7012995665 Enrollment ID: I20040713000021 |
| Provider Name | Serena Aunon Chancellor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023177821 PECOS PAC ID: 6709865132 Enrollment ID: I20040719000376 |
| Provider Name | Michele L Garant Smotherman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154328862 PECOS PAC ID: 7416919246 Enrollment ID: I20041103000225 |
| Provider Name | Joyce P Hnatek |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1396708095 PECOS PAC ID: 6709842115 Enrollment ID: I20041207001279 |
| Provider Name | Gabriel A Neal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841243946 PECOS PAC ID: 9032185079 Enrollment ID: I20060216000088 |
| Provider Name | Jennifer Friedman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1790893600 PECOS PAC ID: 6608778881 Enrollment ID: I20070201000478 |
| Provider Name | Robert A Harper |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457332959 PECOS PAC ID: 5991735094 Enrollment ID: I20080507000210 |
| Provider Name | Anna Lichorad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750392056 PECOS PAC ID: 9739247255 Enrollment ID: I20081027000771 |
| Provider Name | Robert Pope |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518979103 PECOS PAC ID: 5294893723 Enrollment ID: I20081027000873 |
| Provider Name | Paula K Shireman |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1043229081 PECOS PAC ID: 3375690316 Enrollment ID: I20090409000241 |
| Provider Name | Robert O Carpenter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1750438545 PECOS PAC ID: 6608947775 Enrollment ID: I20091130000186 |
| Provider Name | Carl Wei-chan Tong |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1992760276 PECOS PAC ID: 9335324417 Enrollment ID: I20110505000387 |
| Provider Name | Rae A Adams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508019001 PECOS PAC ID: 2062682594 Enrollment ID: I20110819000085 |
| Provider Name | Laurie K Seremetis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396976668 PECOS PAC ID: 0840466041 Enrollment ID: I20120109000948 |
| Provider Name | Laura E Marsh |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1750602199 PECOS PAC ID: 1658509021 Enrollment ID: I20140109000941 |
| Provider Name | Joel B Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336409093 PECOS PAC ID: 0446473854 Enrollment ID: I20140603000491 |
| Provider Name | Hector Chapa |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1568483022 PECOS PAC ID: 4981820610 Enrollment ID: I20140801000245 |
| Provider Name | Katherine E Blalock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083996177 PECOS PAC ID: 0547582116 Enrollment ID: I20141210000746 |
| Provider Name | Brandon T Williamson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457797375 PECOS PAC ID: 4587978309 Enrollment ID: I20150806010757 |
| Provider Name | Jason R Mcknight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023429321 PECOS PAC ID: 4082914080 Enrollment ID: I20151124000191 |
| Provider Name | Jennifer J Light |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1013387083 PECOS PAC ID: 1153621057 Enrollment ID: I20151125001422 |
| Provider Name | Amanda Bray |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972863223 PECOS PAC ID: 0547550188 Enrollment ID: I20160609001441 |
| Provider Name | Bradley Bogdan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487907366 PECOS PAC ID: 8426341983 Enrollment ID: I20160721001933 |
| Provider Name | Marianela Gonzalez |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316138803 PECOS PAC ID: 9436439270 Enrollment ID: I20161213001076 |
| Provider Name | Meredith Williamson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891157707 PECOS PAC ID: 9436426004 Enrollment ID: I20170602000303 |
| Provider Name | John M Hettema |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639259088 PECOS PAC ID: 3870634744 Enrollment ID: I20191111001035 |
| Provider Name | Albert Lo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396730388 PECOS PAC ID: 3577613199 Enrollment ID: I20200623000231 |
| Provider Name | Jennifer Tejada Oller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376920132 PECOS PAC ID: 8426473851 Enrollment ID: I20200803001278 |
| Provider Name | Sarah Greer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669072708 PECOS PAC ID: 2466865829 Enrollment ID: I20210105000728 |
| Provider Name | Suzette Grier Bosveld |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013181163 PECOS PAC ID: 3173938529 Enrollment ID: I20210216002461 |
| Provider Name | Patti H Savage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326636051 PECOS PAC ID: 8426464314 Enrollment ID: I20210301000640 |
| Provider Name | Miranda Wang |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508397175 PECOS PAC ID: 1355742164 Enrollment ID: I20210630004289 |
| Provider Name | Colleen Neal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881279883 PECOS PAC ID: 4385035799 Enrollment ID: I20211220000298 |
| Provider Name | Jim Hudson Chung |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750764460 PECOS PAC ID: 8123317674 Enrollment ID: I20220322000865 |
| Provider Name | Serene Selli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992331888 PECOS PAC ID: 9436571932 Enrollment ID: I20220420002592 |
| Provider Name | Katelyn Jo Light |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477189355 PECOS PAC ID: 7315369881 Enrollment ID: I20220523000775 |
| Provider Name | Tiffany Elizabeth Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700247285 PECOS PAC ID: 5193106953 Enrollment ID: I20220726000306 |
| Provider Name | Stephen Wesley Line |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306342431 PECOS PAC ID: 2062894546 Enrollment ID: I20220729002959 |
| Provider Name | Elizabeth Nguyen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295265593 PECOS PAC ID: 0042611766 Enrollment ID: I20221003002084 |
| Provider Name | Gustavo Eduardo Tafet |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649973959 PECOS PAC ID: 1153788104 Enrollment ID: I20230606002384 |
| Provider Name | Clayton Thomas Kruger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003376591 PECOS PAC ID: 0446622161 Enrollment ID: I20230613000626 |
| Provider Name | Charlotte Toney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861020307 PECOS PAC ID: 8820414980 Enrollment ID: I20230706000219 |
| Provider Name | Camille Merhi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043731920 PECOS PAC ID: 0941662258 Enrollment ID: I20230818001161 |
| Provider Name | Kasey Rae Golden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548971526 PECOS PAC ID: 0143677740 Enrollment ID: I20231102003965 |
| Provider Name | Tal Nesichi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023604279 PECOS PAC ID: 8022468586 Enrollment ID: I20231223000081 |
| Provider Name | Alexya Jayde Drummond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942956768 PECOS PAC ID: 4981048683 Enrollment ID: I20240221003156 |
| Provider Name | Alyssa Eckert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669183646 PECOS PAC ID: 1759722895 Enrollment ID: I20240507003555 |
| Provider Name | Annette M Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366828477 PECOS PAC ID: 1355659822 Enrollment ID: I20240514000415 |
| Provider Name | Calli Fry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326676123 PECOS PAC ID: 1557784584 Enrollment ID: I20240709004502 |
| Provider Name | Kaylee Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558982298 PECOS PAC ID: 3971039934 Enrollment ID: I20241213001594 |
J. T. L. Mcnew, M.d., Faafp Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 Sulphur Springs Rd, Bryan, TX 77801 Phone: 979-823-8101 Fax: 979-822-7620 | |
Davis P Buras Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3201 University Dr E Ste 345, Bryan, TX 77802 Phone: 979-776-4797 Fax: 979-776-9502 | |
Texas Cardiac Arrhythmia Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2605 Osler Blvd, Bryan, TX 77802 Phone: 979-774-4008 | |
Ricardo S. Lemos Md Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2716 Osler Blvd, Bryan, TX 77802 Phone: 979-776-3850 Fax: 979-776-3890 | |