Individual provider Active NPI

Mushtaba Yuridullah

  • Emergency Medicine Physician
  • Round Rock, TX
National Provider Identifier
1306307939
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
U3699 Issued in TX
Practice address
300 University Blvd
Round Rock, TX 78665-1032
Phone
(512) 509-0100
NPI assigned
Mar 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X U3699 TX Primary

Addresses

Primary practice location

300 University Blvd
Round Rock, TX 78665-1032

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (800) 994-0371

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address myuridullah1198906@direct.sw.org Direct

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
I20230628001618 TX Practitioner - Emergency Medicine 8325376940 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
U3699TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Hospital - Taylor Current Accepting new patients
Century Integrated Partners, Inc Emergency Medicine CurrentSince Jun 12, 2023 Accepting new patients
Scott & White Hospital - Taylor CurrentSince Jun 12, 2023 Accepting new patients
Scott & White Hospital - Taylor Emergency Medicine CurrentSince Jun 12, 2023 Accepting new patients

Locations

5245 W Highway 290
Austin, TX 78735
Phone (512) 509-0100

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

2600 E Pflugerville Pkwy
Ste 100
Pflugerville, TX 78660
Phone (512) 654-6100

4700 Alliance Blvd
#P
Plano, TX 75093
Phone (469) 814-2000

300 University Blvd
Round Rock, TX 78665
Phone (512) 509-0100

305 Mallard Ln
Taylor, TX 76574
Phone (512) 352-7611

Interoperability endpoints

  • Direct secure messaging: myuridullah1198906@direct.sw.org

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1306307939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "800-994-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YURIDULLAH",
        "first_name": "MUSHTABA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-27",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "U3699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "myuridullah1198906@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 University Blvd",
            "city": "Round Rock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786651032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.