NPIMap

Organization Active NPI

Pecan Valley MHMR Region

Doing business as Pecan Valley Centers

  • Primary Care Nurse Practitioner
  • Cleburne, TX
National Provider Identifier
1285342295
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PECAN VALLEY MHMR REGION
Doing business as
Pecan Valley Centers
Practice address
1601 N Anglin St
Cleburne, TX 76031-1835
Phone
(817) 558-1121
NPI assigned
Nov 8, 2022
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Michelle L Leonard
Title
Billing Manager
Phone
(817) 579-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

1601 N Anglin St
Cleburne, TX 76031-1835

Mailing address

2101 W Pearl St
Granbury, TX 76048-1894
Phone (817) 579-4400

Other names 1

  • Pecan Valley Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050301000171 TX Part B Supplier - Clinic/Group Practice 4688627706 Receives reassigned benefits from 28 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weatherford, TX; Geln Rose, TX; Stephenville, TX; Mineral Wells, TX; Granbury, TX; Cleburne, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pecan Valley MHMR Region23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

209 SW Barnard St
#B
Glen Rose, TX 76043
Phone (254) 897-4337

301 E Gibbs Blvd
Glen Rose, TX 76043
Phone (254) 552-2090

1715 Santa Fe Dr
Weatherford, TX 76086
Phone (817) 579-4400

Practitioners & affiliated clinicians

Practitioners 39

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.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1285342295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 W PEARL ST",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481894",
            "telephone_number": "817-579-4400",
            "fax_number": "866-452-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 N ANGLIN ST",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760311835",
            "telephone_number": "817-558-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY MHMR REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "817-579-4400"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pecan Valley Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleburne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.