-HHSD Immunization Program – Family Medicine Physician, NPI 1568635803
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for -HHSD Immunization Program
15 Waller St Fl 1
Austin, TX 787025240
Phone: (737) 210-0296
Type: Location
7500 BLESSING AVE
AUSTIN, TX 787521716
Phone: (512) 972-5554
Fax: (512) 978-7556
Type: Location
Rebekah Baines Johnson Health Center, 15, Waller Street, East Cesar Chavez, Austin, Travis County, Texas, 78702, United States
AUSTIN, TX 787025240
Phone: (512) 972-5529
Fax: (512) 972-6225
Type: Location
15 Waller St Fl 3
Austin, TX 787025240
Phone: (512) 972-4421
Fax: (512) 978-7556
Type: Location
15 WALLER ST FL 3
AUSTIN, TX 787025240
Phone: (512) 972-4421
Fax: (512) 978-7556
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-02-01
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050201000602 | O | Mass Immunization (Roster Biller Only) | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 78702)
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