Jennifer Urbani Premo, EDDIAGNOSTICIANMED

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Practice address

4125 Beechwood LN
Dallas, TX 75220-1905

Phone

(214) 532-6726

NPI assigned

Sep 10, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1083229611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4125 BEECHWOOD LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752201905",
            "telephone_number": "214-532-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 BEECHWOOD LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752201905",
            "telephone_number": "214-532-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREMO",
        "first_name": "JENNIFER",
        "middle_name": "URBANI",
        "credential": "EDDIAGNOSTICIANMED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "JumpStartStudentSuccess.com",
            "affiliation": "N",
            "address_1": "4125 Beechwood Ln",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752201905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Premise Health of Texas Medical P a (Premise Health Clinic)
• Premise Health of Texas Medical PA (AT & T Health and Wellness Center)
• Premise Health of Texas Medical PA (Ross Avenue Health Center)
• Premise Health of Texas Medical PA (TESS - Dallas)
• Premium Lab Services LLC
• Irving David Prengler, MD
• Rebecca Prengler, MD
• Yosef Presburger
• Presbyterian Apothecary
• Presbyterian Hospital

• Adolescent and Children Mental Health Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Adolescent and Children Mental Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.