NPIMap

Organization Active NPI

Pediatric Associates of Wylie, P.a.

  • Pediatrics Physician
  • Wylie, TX
National Provider Identifier
1215068309
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF WYLIE, P.A.
Practice address
501 Woodbridge Parkway
Wylie, TX 75098
Phone
(972) 442-2300
Fax
(972) 442-2180
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Authorized official

Name
Mrs. Ruth A. Strother
Title
Billing Manager
Phone
(972) 442-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

501 Woodbridge Parkway
Wylie, TX 75098

Mailing address

PO Box 125
Wylie, TX 75098-0125
Phone (972) 442-2300

Other identifiers 3

IdentifierTypeStateIssuer
174061501MedicaidTX
174061502MedicaidTX
0066MSOtherTXBCBS

National Provider Directory

National Provider Directory

Locations

2730 Country Club Rd
Ste B
Lucas, TX 75002
Phone (972) 442-2300

501 Woodbridge Pkwy
Wylie, TX 75098
Phone (972) 442-2300

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362009600000",
    "number": "1215068309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 125",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "750980125",
            "telephone_number": "972-442-2300",
            "fax_number": "972-442-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 WOODBRIDGE PARKWAY",
            "city": "WYLIE",
            "state": "TX",
            "postal_code": "75098",
            "telephone_number": "972-442-2300",
            "fax_number": "972-442-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF WYLIE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2013-02-28",
        "status": "A",
        "authorized_official_last_name": "STROTHER",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "972-442-2300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174061501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174061502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0066MS",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wylie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; 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.