Individual provider Active NPI

Erika Brucks, DO

  • Pediatrics Physician
  • Fort Worth, TX
National Provider Identifier
1174104673
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
V1040 Issued in TX
Practice address
6401 Harris Pkwy Ste 100
Fort Worth, TX 76132-6100
Phone
(817) 346-2525
Fax
(817) 294-1692
NPI assigned
Apr 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X BP10075272 TX
Pediatrics Physician 208000000X V1040 TX Primary

Addresses

Primary practice location

6401 Harris Pkwy Ste 100
Fort Worth, TX 76132-6100

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-1855

Other names 1

  • Erika Rudolph Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ebrucks215499@CookChildrens.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240802000305 TX Practitioner - Pediatric Medicine 9133666589 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
BP10075272TXMDPediatrics Physician
V1040TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children'S Physician Network Pediatrics CurrentSince Aug 26, 2024 Accepting new patients
Cook Children'S Physician Network Pediatrics CurrentSince Aug 26, 2024 Accepting new patients

Locations

6401 Harris Pkwy
Ste 100
Fort Worth, TX 76132
Phone (817) 346-2525

7000 Calmont Ave
Ste 150
Fort Worth, TX 76116
Phone (682) 885-6163

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

136 El Chico Trl
Ste 102
Willow Park, TX 76087
Phone (817) 441-5412

Interoperability endpoints

  • Direct secure messaging: ebrucks215499@cookchildrens.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1174104673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 HARRIS PKWY STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761326100",
            "telephone_number": "817-346-2525",
            "fax_number": "817-294-1692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKS",
        "first_name": "ERIKA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "BP10075272",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V1040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebrucks215499@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "6401 Harris Pkwy Ste 100",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761326100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ERIKA",
            "last_name": "RUDOLPH",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.