Active NPI
Erika Brucks, DO
- Pediatrics Physician
- Fort Worth, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- V1040
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| BP10075272 | TX | MD | Pediatrics Physician |
| V1040 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook Children'S Physician Network | Pediatrics | Current | Accepting new patients |
| Cook Children'S Physician Network | Pediatrics | Current | 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
- 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.