NPIMap

Organization Active NPI

Modera Clinic Gi, PLLC

Doing business as Modera GI

  • Gastroenterology Physician
  • Frisco, TX
National Provider Identifier
1063142115
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MODERA CLINIC GI, PLLC
Doing business as
Modera GI
Practice address
5575 Frisco Square Blvd
220
Frisco, TX 75034-3303
Phone
(469) 920-2302
NPI assigned
Jun 13, 2022
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Dr. Trevor Huber, DONPI 1649682857
Title
President
Phone
(972) 987-0458

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

5575 Frisco Square Blvd
220
Frisco, TX 75034-3303

Mailing address

5575 Frisco Square Blvd
#220
Frisco, TX 75034-3303
Phone (469) 920-2302

Other names 1

  • Modera GI Doing business as

National Provider Directory

National Provider Directory

Locations

5575 Frisco Square Blvd
Ste 220
Frisco, TX 75034
Phone (469) 557-5434

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1063142115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5575 FRISCO SQUARE BLVD",
            "address_2": "#220",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750343303",
            "telephone_number": "469-920-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 FRISCO SQUARE BLVD",
            "address_2": "220",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750343303",
            "telephone_number": "469-920-2302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERA CLINIC GI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-13",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-987-0458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modera GI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Modera GI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.