Individual provider Active NPI

Peace Dorothy Imani, M.D.

  • Pediatric Nephrology Physician
  • Houston, TX, TX
National Provider Identifier
1265859755
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
580808 Issued in TX
Practice address
1102 Bates Ave.,
Baylor College of Medicine
Houston, TX, TX 77030
Phone
(832) 824-3800
NPI assigned
Mar 24, 2014
Last updated
May 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X 580808 TX Primary

Addresses

Primary practice location

1102 Bates Ave.,
Baylor College of Medicine
Houston, TX, TX 77030

Mailing address

1102 Bates Ave Ste 245
Houston, TX 77030-2619
Phone (832) 824-3800

Other identifiers 1

IdentifierTypeStateIssuer
1265859755MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address imani@bcm.edu Health Information Exchange (HIE)

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
I20190724002847 TX Practitioner - Nephrology 1456687763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Childrens Physician GroupGroup PAC ID 4385722081, 661 clinicians

Practice addresses (Care Compare)

6701 Fannin St
Houston, TX 77030-2608
Phone (832) 824-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
580808TXMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children's Physician Group Multi-Specialty CurrentSince Jul 1, 2019 Accepting new patients

Locations

1102 Bates Ave
Houston, TX 77030
Phone (832) 822-4556

1102 Bates Ave
Ste 245
Houston, TX 77030
Phone (832) 824-3800

2450 Holcombe Blvd
Ste NB34L
Houston, TX 77021
Phone (713) 796-0003

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

Interoperability endpoints

  • Direct secure messaging: pimani163372@prddirect.texaschildrens.org

Organizations & group practices 1

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1265859755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 BATES AVE STE 245",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302619",
            "telephone_number": "832-824-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BATES AVE.,",
            "address_2": "BAYLOR COLLEGE OF MEDICINE",
            "city": "HOUSTON, TX",
            "state": "TX",
            "postal_code": "77030",
            "telephone_number": "832-824-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMANI",
        "first_name": "PEACE",
        "middle_name": "DOROTHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-24",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "TX",
            "license": "580808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265859755",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "imani@bcm.edu",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1102 Bates Ave.,",
            "address_2": "Baylor College of Medicine",
            "city": "Houston, TX",
            "state": "TX",
            "country_code": "US",
            "postal_code": "77030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Houston, TX, TX

Sources for this page

Verify at the official NPI Registry.