NPIMap

Organization Active NPI

Fannett Family Medical Center

  • Primary Care Clinic/Center
  • Beaumont, TX
National Provider Identifier
1245781541
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
AP127771 Issued in TX
Legal business name
FANNETT FAMILY MEDICAL CENTER
Practice address
15321 Highway 124
Beaumont, TX 77705-9127
Phone
(409) 794-2314
NPI assigned
Oct 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Authorized official

Name
Mrs. Daisy Arco, NURSE PRACTITIONER
Title
FNP-C
Phone
(409) 794-2314

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Primary Care Clinic/Center 261QP2300X AP127771 TX Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

15321 Highway 124
Beaumont, TX 77705-9127

Mailing address

15321 Highway 124
Beaumont, TX 77705-9127
Phone (409) 794-2314

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171115000995 TX Part B Supplier - Clinic/Group Practice 8022374610 Receives reassigned benefits from 3 practitioners
Practice locations: Beaumont, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1245781541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15321 HIGHWAY 124",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777059127",
            "telephone_number": "409-794-2314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15321 HIGHWAY 124",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777059127",
            "telephone_number": "409-794-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANNETT FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-21",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "ARCO",
        "authorized_official_first_name": "DAISY",
        "authorized_official_title_or_position": "FNP-C",
        "authorized_official_telephone_number": "409-794-2314",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP127771",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.