NPIMap

Organization Active NPI

MD Pediatric Associates, P.a.

  • Pediatrics Physician
  • Coppell, TX
National Provider Identifier
1013922731
Registry record updated Feb 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MD PEDIATRIC ASSOCIATES, P.A.
Practice address
760 N Denton Tap Rd
Suite 130
Coppell, TX 75019-2163
Phone
(972) 420-1475
Fax
(214) 222-2435
NPI assigned
Jul 30, 2006
Last updated
Feb 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark W Holt, M.D.NPI 1346241528
Title
President
Phone
(972) 420-1475

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

760 N Denton Tap Rd
Suite 130
Coppell, TX 75019-2163

Mailing address

PO Box 2429
Coppell, TX 75019-8429
Phone (972) 420-1475

Other names 1

  • MD Pediatric Associates Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1047661MD Pediatric Associates - Coppell Laboratory760 N Denton Tap Rd #120, Coppell, TX 75019Certificate of waiverMar 17, 2028

National Provider Directory

National Provider Directory

Locations

760 N Denton Tap Rd
Ste 120
Coppell, TX 75019
Phone (972) 420-1475

760 N Denton Tap Rd
Ste 130
Coppell, TX 75019
Phone (972) 420-1475

2560 Central Park Ave
Ste 195
Flower Mound, TX 75028
Phone (972) 420-1475

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329436800000",
    "number": "1013922731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2429",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750198429",
            "telephone_number": "972-420-1475",
            "fax_number": "214-222-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 N DENTON TAP RD",
            "address_2": "SUITE 130",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192163",
            "telephone_number": "972-420-1475",
            "fax_number": "214-222-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD PEDIATRIC ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2012-02-17",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-420-1475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD Pediatric Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coppell, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.