NPIMap

Organization Active NPI

Pecan Tree Pediatrics, P.a.

  • Pediatrics Physician
  • Rockwall, TX
National Provider Identifier
1073802724
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J9870 Issued in TX
Legal business name
PECAN TREE PEDIATRICS, P.A.
Practice address
201 E I30 Ste 100
Rockwall, TX 75087-5402
Phone
(972) 772-3100
Fax
(469) 757-4890
NPI assigned
Apr 4, 2011
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Authorized official

Name
Dr. Casey Ellen Drake, M.D.NPI 1114986254
Title
President
Phone
(972) 772-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X J9870 TX Primary

Addresses

Primary practice location

201 E I30 Ste 100
Rockwall, TX 75087-5402

Mailing address

201 E I30 Ste 100
Rockwall, TX 75087-5402
Phone (972) 772-3100

National Provider Directory

National Provider Directory

Locations

201 E Interstate 30
Ste 100
Rockwall, TX 75087
Phone (972) 772-3100

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1073802724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E I30 STE 100",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875402",
            "telephone_number": "972-772-3100",
            "fax_number": "469-757-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E I30 STE 100",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875402",
            "telephone_number": "972-772-3100",
            "fax_number": "469-757-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN TREE PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "CASEY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-772-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J9870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.