NPIMap

Organization Active NPI

Modern MD PLLC

  • Family Medicine Physician
  • El Paso, TX
National Provider Identifier
1104412931
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MODERN MD PLLC
Practice address
5915 Silver Springs Dr BLDG 3a
El Paso, TX 79912-4126
Phone
(915) 228-3080
NPI assigned
Dec 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Authorized official

Name
Dr. Patricia Lopez-PO, MDNPI 1467797811
Title
President
Phone
(915) 228-3080

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5915 Silver Springs Dr BLDG 3a
El Paso, TX 79912-4126

Mailing address

4849 N Mesa St Ste 201
El Paso, TX 79912-5919
Phone (915) 351-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210104000851 TX Part B Supplier - Clinic/Group Practice 9133532542 Receives reassigned benefits from 3 practitioners
Practice locations: El Paso, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2219336Modern MD PLLC5915 Silver Springs, El Paso, TX 79912Certificate of waiverApr 4, 2027

National Provider Directory

National Provider Directory

Locations

5915 Silver Springs Dr
El Paso, TX 79912
Phone (915) 228-3080

5915 Silver Springs Dr
Bldg 3A
El Paso, TX 79912
Phone (706) 296-8632

5915 Silver Springs Dr
Bldg 2B
El Paso, TX 79912

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1104412931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4849 N MESA ST STE 201",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799125919",
            "telephone_number": "915-351-6600",
            "fax_number": "915-351-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 SILVER SPRINGS DR BLDG 3A",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799124126",
            "telephone_number": "915-228-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "LOPEZ-PO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "915-228-3080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.