NPIMap

Organization Active NPI

Extant PLLC

  • Interventional Pain Medicine Physician
  • Missouri City, TX
National Provider Identifier
1407555865
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
EXTANT PLLC
Practice address
3550 FM 1092 Rd Ste a
Missouri City, TX 77459-2203
Phone
(832) 409-1460
NPI assigned
Feb 24, 2023
Last updated
Feb 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Christian D Peccora, MDNPI 1275853830
Title
Owner/MD
Phone
(832) 409-1460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

3550 FM 1092 Rd Ste a
Missouri City, TX 77459-2203

Mailing address

3550 FM 1092 Rd Ste 200
Missouri City, TX 77459-2203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230503000723 TX Part B Supplier - Clinic/Group Practice 3678938396 Receives reassigned benefits from 10 practitioners
Practice locations: Missouri City, TX
O20231110000802 TX DME Supplier - Physician - Anesthesiology 3678938396 Practice locations: Missouri City, TX

National Provider Directory

National Provider Directory

Locations

3550 FM 1092 Rd
#A
Missouri City, TX 77459

3550 FM 1092 Rd
Ste 200
Missouri City, TX 77459

3550 FM 1092 Rd
Ste A
Missouri City, TX 77459
Phone (832) 409-1460

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1407555865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 FM 1092 RD STE 200",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774592203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 FM 1092 RD STE A",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774592203",
            "telephone_number": "832-409-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTANT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "PECCORA",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "832-409-1460",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missouri City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.