NPIMap

Organization Active NPI

Dallas County Hospital District

Doing business as Pediatric Primary Care Center

  • Pediatrics Physician
  • Dallas, TX
National Provider Identifier
1093754475
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DALLAS COUNTY HOSPITAL DISTRICT
Doing business as
Pediatric Primary Care Center
Practice address
5151 Maple Ave # 6B
Dallas, TX 75235-8136
Phone
(214) 266-0110
Fax
(214) 266-0113
NPI assigned
Jun 4, 2006
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Fredrick P. Cerise, M.D.
Title
President & Chief Executive Officer
Phone
(214) 590-8006

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

5151 Maple Ave # 6B
Dallas, TX 75235-8136

Mailing address

PO Box 660599
Dallas, TX 75266-0599

Other identifiers 3

IdentifierTypeStateIssuer
133247005MedicaidTX
111924002MedicaidTX
111924001MedicaidTX

Other names 1

  • Pediatric Primary Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000583 TX Part B Supplier - Clinic/Group Practice 8325934813 Receives reassigned benefits from 932 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dallas, TX; Irving, TX; Grand Prairie, TX; Garland, TX; Farmers Branch, TX
O20060918000188 TX Part A Provider - Hospital 8325934813 44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093754475. Details of each certification follow.

Hospital certification: CCN 450015

Legal name
DALLAS COUNTY HOSPITAL DISTRICT
Doing business as
PARKLAND HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 14, 2024
Beds
968
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
5200 Harry Hines Blvd
Dallas, TX 75235-7709
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 49

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 49

Care Compare: Hospital

Medicare Care Compare
Listed as
Parkland Health & Hospital SystemCCN 450015 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Dallas Cnty Hospital Di94 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Frederick P Cerise Individual Corporate OfficerChief Executive Officer Mar 24, 2014 100%
Operational/Managerial ControlPresident Chief Executive Office Mar 24, 2014
Gerry Baker Individual Corporate DirectorSr VP Revenue Cycle Apr 29, 2021
W-2 Managing EmployeeSr VP Revenue Cycle Apr 29, 2021
Dallas County Hospital District Organization, Dallas, TX Corporation Operational/Managerial Control Apr 22, 1966
Errica Brown Individual W-2 Managing EmployeeProvider Enrollment Program Mana Oct 13, 2020

Practitioners & affiliated clinicians

Practitioners 8

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.

Affiliated clinicians 1,656

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,656

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1093754475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660599",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 MAPLE AVE # 6B",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752358136",
            "telephone_number": "214-266-0110",
            "fax_number": "214-266-0113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "CERISE",
        "authorized_official_first_name": "FREDRICK",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-590-8006",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133247005",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111924002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111924001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.