NPIMap

Organization Active NPI

Pharr Pediatric Clinic, PA

  • Pediatrics Physician
  • Pharr, TX
National Provider Identifier
1073695441
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J2456 Issued in TX
Legal business name
PHARR PEDIATRIC CLINIC, PA
Practice address
105 E Polk Ave
Pharr, TX 78577-3110
Phone
(956) 781-6591
Fax
(956) 702-0185
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

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

Authorized official

Name
Israel Mata, M.D.
Title
Physician
Phone
(956) 781-6591

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X J2456 TX Primary

Addresses

Primary practice location

105 E Polk Ave
Pharr, TX 78577-3110

Mailing address

105 E Polk Ave
Pharr, TX 78577-3110
Phone (956) 781-6591

Other identifiers 1

IdentifierTypeStateIssuer
178958801MedicaidTX

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1073695441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E POLK AVE",
            "city": "PHARR",
            "state": "TX",
            "postal_code": "785773110",
            "telephone_number": "956-781-6591",
            "fax_number": "956-702-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E POLK AVE",
            "city": "PHARR",
            "state": "TX",
            "postal_code": "785773110",
            "telephone_number": "956-781-6591",
            "fax_number": "956-702-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARR PEDIATRIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "956-781-6591",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J2456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178958801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pharr, TX

Sources for this page

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