NPIMap

Organization Active NPI

Cook Children's Medical Center

Doing business as Cook Childrens Urgent Care Southlake

  • Urgent Care Clinic/Center
  • Southlake, TX
National Provider Identifier
1134422884
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
000332 Issued in TX
Legal business name
COOK CHILDREN'S MEDICAL CENTER
Doing business as
Cook Childrens Urgent Care Southlake
Practice address
2727 E Southlake Blvd
Southlake, TX 76092-6613
Phone
(682) 885-6000
Fax
(682) 885-6050
NPI assigned
Dec 17, 2010
Last updated
May 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COOK CHILDREN'S MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Authorized official

Name
Cory R Rhoades
Title
Chief Financial Officer
Phone
(682) 885-4480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 000332 TX Primary

Addresses

Primary practice location

2727 E Southlake Blvd
Southlake, TX 76092-6613

Mailing address

PO Box 99213
Fort Worth, TX 76199-0213
Phone (682) 885-1860

Other names 1

  • COOK CHILDRENS URGENT CARE SOUTHLAKE Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address SLK_URGENT_CARE_STAFF_POOL200640@COOKCHILDRENS.DIRECT-CI.COM
Direct Messaging Address slk_urgent_care_staff_pool200640@CookChildrens.direct-ci.com COOK CHILDREN'S MEDICAL CENTER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080909000374 TX Part A Provider - Hospital 5597757740 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Worth, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134422884. Details of each certification follow.

Hospital certification: CCN 453300

Legal name
COOK CHILDREN'S MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Oct 1, 1983
Last certification
Mar 12, 2025
Beds
462
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 25, 1985 in TX
Enrollment address
801 7TH Ave
Fort Worth, TX 76104-2733
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Children’s

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Cook Childrens Medical CenterCCN 453300 · All quality measures
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Cook Fort Worth Childre

Locations

7000 Calmont Ave
#2
Fort Worth, TX 76116
Phone (682) 885-4061

Interoperability endpoints

  • Direct secure messaging: slk_urgent_care_staff_pool200640@cookchildrens.direct-ci.com

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Andrew S Wayne Individual Corporate OfficerVice Chairman/Board Member Jun 1, 2024
William Walton Jones Individual Corporate OfficerBoard Member Jun 1, 2019
Jeffrey L Cureton Individual Corporate OfficerBoard Member Jun 1, 2019
Laura S Miller Individual Corporate OfficerBoard Member Jun 1, 2022
Bonnie Petsche Individual Corporate OfficerBoard Member Jun 1, 2021
Ryan B Dickerson Individual Corporate OfficerBoard Member Jun 1, 2019
John P Boswell Individual Corporate DirectorSecretary/Treasurer Jun 1, 2023
Thomas Breckinridge Ray Individual Corporate OfficerBoard Member Jun 1, 2023
Michael a Lagatta Individual Corporate OfficerBoard Member Jun 1, 2019
NA'Im Moses Individual Corporate OfficerBoard Member Jun 1, 2024
Edwin S Ryan Individual Corporate OfficerBoard Member Jun 1, 2023
Cook Childrens Healthcare System Organization, Fort Worth, TX Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 26, 1998
Cory Rhoades Individual Corporate OfficerChief Financial Officer Oct 1, 2019 75%
Terri Von Lehmden Individual Corporate OfficerBoard Member Jun 1, 2025
Peggy L Cassidy Individual Corporate OfficerBoard Member Jun 1, 2023
Kristy Smith Individual W-2 Managing Employee Jun 13, 2008
Tashanna T Oneal Individual W-2 Managing EmployeePayor Relations Analyst May 24, 2019

Practitioners & affiliated clinicians

Affiliated clinicians 86

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

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1134422884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99213",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990213",
            "telephone_number": "682-885-1860",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 E SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926613",
            "telephone_number": "682-885-6000",
            "fax_number": "682-885-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK CHILDREN'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOK CHILDREN'S MEDICAL CENTER",
        "enumeration_date": "2010-12-17",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "RHOADES",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "682-885-4480"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TX",
            "license": "000332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SLK_URGENT_CARE_STAFF_POOL200640@COOKCHILDRENS.DIRECT-CI.COM",
            "affiliation": "N",
            "address_1": "2727 E Southlake Blvd",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760926613",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "slk_urgent_care_staff_pool200640@CookChildrens.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "COOK CHILDREN'S MEDICAL CENTER",
            "address_1": "2727 E Southlake Blvd",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760926613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "COOK CHILDRENS URGENT CARE SOUTHLAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.