NPIMap

Organization Active NPI

1 CP Place PLLC

  • Neurology with Special Qualifications in Child Neurology Physician
  • Plano, TX
National Provider Identifier
1134520182
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
M5074 Issued in TX
Legal business name
1 CP PLACE PLLC
Practice address
7709 San Jacinto PL
Suite 203
Plano, TX 75024-3215
Phone
(469) 331-0030
NPI assigned
Sep 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Authorized official

Name
Dr. Janice Elaine Brunstrom-Hernandez, M.D.NPI 1821014051
Title
Managing Member/ Director
Phone
(314) 223-3306

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
Neurology with Special Qualifications in Child Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0402X M5074 TX Primary

Addresses

Primary practice location

7709 San Jacinto PL
Suite 203
Plano, TX 75024-3215

Mailing address

PO Box 251665
Plano, TX 75025-1515
Phone (469) 331-0030

Other identifiers 1

IdentifierTypeStateIssuer
339119501MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141205001656 TX Part B Supplier - Clinic/Group Practice 1658693460 Receives reassigned benefits from 2 practitioners
Practice locations: Plano, TX

National Provider Directory

National Provider Directory

Locations

7709 San Jacinto Pl
Ste 203
Plano, TX 75024
Phone (469) 331-0030

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18220/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1410220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1134520182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251665",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750251515",
            "telephone_number": "469-331-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7709 SAN JACINTO PL",
            "address_2": "SUITE 203",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243215",
            "telephone_number": "469-331-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1 CP PLACE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-09",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "BRUNSTROM-HERNANDEZ",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "MANAGING MEMBER/ DIRECTOR",
        "authorized_official_telephone_number": "314-223-3306",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "TX",
            "license": "M5074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339119501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.