NPIMap

Organization Active NPI

Modern Pediatrics Professionals, PLLC

  • Pediatrics Physician
  • Austin, TX
National Provider Identifier
1154952505
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MODERN PEDIATRICS PROFESSIONALS, PLLC
Practice address
2309 Santa Maria St
Austin, TX 78702-4617
Phone
(319) 541-7604
NPI assigned
Feb 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Authorized official

Name
Dr. Timothy James Porter, MDNPI 1164780896
Title
Chief Medical Officer
Phone
(319) 541-7604

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2309 Santa Maria St
Austin, TX 78702-4617

Mailing address

2309 Santa Maria St
Austin, TX 78702-4617
Phone (319) 541-7604

National Provider Directory

National Provider Directory

Locations

300 S Colorado St
Ste Ad
Lockhart, TX 78644
Phone (512) 376-9690

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1154952505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 SANTA MARIA ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787024617",
            "telephone_number": "319-541-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 SANTA MARIA ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787024617",
            "telephone_number": "319-541-7604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN PEDIATRICS PROFESSIONALS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "319-541-7604",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.