NPIMap

Organization Active NPI

Centrum Medical Group, PLLC

  • General Practice Physician
  • Dallas, TX
National Provider Identifier
1043963317
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CENTRUM MEDICAL GROUP, PLLC
Practice address
2223 S Buckner Blvd
Dallas, TX 75227-8646
Phone
(800) 218-8989
Fax
(786) 558-0242
NPI assigned
Jan 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Authorized official

Name
Vanessa Victorero
Title
Coo
Phone
(305) 266-2929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2223 S Buckner Blvd
Dallas, TX 75227-8646

Mailing address

9250 NW 36TH St Ste 420
Doral, FL 33178-2775
Phone (305) 266-2929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230117002598 TX Part B Supplier - Clinic/Group Practice 9234500984 Receives reassigned benefits from 42 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Houston, TX; Grapevine, TX; Irving, TX; Katy, TX; Longview, TX; Mansfield, TX; McAllen, TX; Mesquite, TX…

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

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
45D2251739Centrum Medical Group, PLLC2223 S Buckner Blvd, Dallas, TX 75227Certificate of waiverFeb 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Centrum Medical Group PLLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

2223 S Buckner Blvd
Dallas, TX 75227
Phone (972) 708-4000

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1043963317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 NW 36TH ST STE 420",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331782775",
            "telephone_number": "305-266-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 S BUCKNER BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752278646",
            "telephone_number": "800-218-8989",
            "fax_number": "786-558-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRUM MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-27",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "VICTORERO",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-266-2929"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.