Organization Active NPI

Optimum Pediatrics PLLC

  • Pediatrics Physician
  • Mission, TX
National Provider Identifier
1205664828
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
OPTIMUM PEDIATRICS PLLC
Practice address
202 E. Expressway 83 Ste a
Mission, TX 78572
Phone
(956) 585-1638
Fax
(956) 585-9787
NPI assigned
Jul 24, 2024
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Dr. Brandy Beauchamp, MDNPI 1245434844
Title
Ceo
Phone
(956) 283-1889

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 Physician 208000000X NU Primary

Addresses

Primary practice location

202 E. Expressway 83 Ste a
Mission, TX 78572

Mailing address

807 N Cage Blvd
Pharr, TX 78577-3117
Phone (956) 283-1889

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241204003614 TX Part B Supplier - Clinic/Group Practice 2466988159 Receives reassigned benefits from 2 practitioners
Practice locations: Mission, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1205664828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 N CAGE BLVD",
            "city": "PHARR",
            "state": "TX",
            "postal_code": "785773117",
            "telephone_number": "956-283-1889",
            "fax_number": "956-283-7014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E. EXPRESSWAY 83 STE A",
            "city": "MISSION",
            "state": "TX",
            "postal_code": "78572",
            "telephone_number": "956-585-1638",
            "fax_number": "956-585-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAMP",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "956-283-1889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.