NPIMap

Organization Active NPI

Cedar Park Pediatric and Family Medicine

  • Family Medicine Physician
  • Cedar Park, TX
National Provider Identifier
1073644423
Registry record updated Apr 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CEDAR PARK PEDIATRIC AND FAMILY MEDICINE
Practice address
345 Cypress Creek Rd
Suite 104
Cedar Park, TX 78613-4483
Phone
(512) 336-2777
NPI assigned
Mar 8, 2007
Last updated
Apr 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2015

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

Authorized official

Name
Mr. Brent CardwellNPI 1720065709
Title
Office Manager
Phone
(512) 336-2777

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

345 Cypress Creek Rd
Suite 104
Cedar Park, TX 78613-4483

Mailing address

345 Cypress Creek Rd
Suite 104
Cedar Park, TX 78613-4483
Phone (512) 336-2777

Other identifiers 1

IdentifierTypeStateIssuer
0068MSOtherTXBCBS

National Provider Directory

National Provider Directory

Locations

13625 Ronald W Reagan Blvd
Bldg 6
Cedar Park, TX 78613
Phone (512) 336-2777

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1073644423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 CYPRESS CREEK RD",
            "address_2": "SUITE 104",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786134483",
            "telephone_number": "512-336-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 CYPRESS CREEK RD",
            "address_2": "SUITE 104",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786134483",
            "telephone_number": "512-336-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR PARK PEDIATRIC AND FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "CARDWELL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "512-336-2777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0068MS",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.