Purple Hearts Primary Care Services, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP137299 Issued in TX

Legal business name

PURPLE HEARTS PRIMARY CARE SERVICES, PLLC

Practice address

688 W Pioneer Pkwy Ste 120
Grand Prairie, TX 75051-4861

Phone

(817) 969-4651

Fax

(214) 710-2188

NPI assigned

Jun 11, 2018

Last updated

Dec 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Raven Modisette, FNP-C,PMHNP-BC

Title

Ceo

Phone

(817) 969-4651

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Purple Hearts Primary Care Services Former legal business name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1043703358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 ARLINGTON HIGHLANDS BLVD STE 281",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760186036",
            "telephone_number": "817-969-4651",
            "fax_number": "214-710-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 W PIONEER PKWY STE 120",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750514861",
            "telephone_number": "817-969-4651",
            "fax_number": "214-710-2188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Arlington Highlands Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "76018",
            "country_code": "US",
            "telephone_number": "817-695-5035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PURPLE HEARTS PRIMARY CARE SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "MODISETTE",
        "authorized_official_first_name": "RAVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-969-4651",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C,PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP137299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "393575101",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "purpleheartscms@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "688 W Pioneer Pkwy Ste 120",
            "city": "Grand Prairie",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750514861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Purple Hearts Primary Care Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Primary Care Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.