Active NPI
Mobile MD PA
- Internal Medicine Physician
- McKinney, TX
National Provider Identifier
1306933718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- MOBILE MD PA
- Practice address
- 4201 Medical Center Dr Ste 280
McKinney, TX 75069-1767 - Phone
- (972) 822-5973
- Fax
- (972) 704-2936
- NPI assigned
- Oct 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jackie Gwyn Judd
- Title
- Manager
- Phone
- (972) 975-8759
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
4201 Medical Center Dr Ste 280
McKinney, TX 75069-1767
Mailing address
4201 Medical Center Dr Ste 280
McKinney, TX 75069-1767
Phone (469) 975-8480
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 169038002 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040621000031 | TX | Part B Supplier - Clinic/Group Practice | 5395720882 |
Receives reassigned benefits from 16 practitioners Practice locations: McKinney, TX |
National Provider Directory
National Provider DirectoryLocations
1200 Summit Ave
Ste 120
Fort Worth, TX 76102
Phone (817) 338-4400
253 Enterprise Dr
McKinney, TX 75069
Phone (972) 542-2695
4201 Medical Center Dr
Ste 360
McKinney, TX 75069
Phone (469) 975-8480
2918 Coit Rd
Plano, TX 75075
Phone (972) 618-3019
Practitioners & affiliated clinicians
Practitioners 19
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": "1160092800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705622400000",
"number": "1306933718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 MEDICAL CENTER DR STE 280",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691767",
"telephone_number": "469-975-8480",
"fax_number": "972-704-2936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 MEDICAL CENTER DR STE 280",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691767",
"telephone_number": "972-822-5973",
"fax_number": "972-704-2936"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOBILE MD PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-06",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A",
"authorized_official_last_name": "JUDD",
"authorized_official_first_name": "JACKIE",
"authorized_official_middle_name": "GWYN",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "972-975-8759"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "169038002",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in McKinney, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.