NPIMap

Organization Active NPI

Rainbow Children's Clinic, P.a.

  • Pediatrics Physician
  • Grand Prairie, TX
National Provider Identifier
1407021413
Registry record updated Sep 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
J8913 Issued in TX
Legal business name
RAINBOW CHILDREN'S CLINIC, P.A.
Practice address
2985 S State Highway 360
Suite 140
Grand Prairie, TX 75052-7615
Phone
(972) 602-1166
Fax
(972) 602-1160
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2016

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

Authorized official

Name
Dr. Ruth Bernardez Tan, M.D.
Title
President/Owner
Phone
(972) 602-1166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X J8913 TX Primary

Addresses

Primary practice location

2985 S State Highway 360
Suite 140
Grand Prairie, TX 75052-7615

Mailing address

2985 S State Highway 360
Suite 140
Grand Prairie, TX 75052-7615
Phone (972) 602-1166

Other identifiers 5

IdentifierTypeStateIssuer
197309102MedicaidTX
197309101MedicaidTX
045321904MedicaidTX
G19885OtherTXUPIN
045321903MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Rainbow Children's Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2985 S State Highway 360
Ste 140
Grand Prairie, TX 75052
Phone (972) 602-1166

Practitioners & affiliated clinicians

Practitioners 4

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": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473120000000",
    "number": "1407021413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2985 S STATE HIGHWAY 360",
            "address_2": "SUITE 140",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750527615",
            "telephone_number": "972-602-1166",
            "fax_number": "972-602-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2985 S STATE HIGHWAY 360",
            "address_2": "SUITE 140",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750527615",
            "telephone_number": "972-602-1166",
            "fax_number": "972-602-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINBOW CHILDREN'S CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2016-09-06",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "BERNARDEZ",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "972-602-1166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "J8913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197309102",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197309101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045321904",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "G19885",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045321903",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.