Individual provider Active NPI

Erica J Zwernemann, M.D.

  • Pediatrics Physician
  • Southlake, TX
National Provider Identifier
1427079300
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L0731 Issued in TX
Practice address
731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377
Phone
(817) 912-8800
Fax
(817) 912-8810
NPI assigned
Jul 23, 2006
Last updated
Mar 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X L0731 TX Primary

Addresses

Primary practice location

731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377

Mailing address

731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6377
Phone (817) 912-8800

Other identifiers 3

IdentifierTypeStateIssuer
045546102MedicaidTX
85496XOtherTXBCBS
045546101MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ezwernemann224852@direct.sw.org

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
I20060418000330 TX Practitioner - Pediatric Medicine 8022027168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Texas Medical Branch at Galveston, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

731 E Southlake Blvd
Suite 100
Southlake, TX 76092-6378
Phone (817) 424-3366

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L0731TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Feb 1, 2016 Accepting new patients
Healthtexas Provider Network CurrentSince Feb 1, 2016 Accepting new patients
Healthtexas Provider Network Pediatrics Current Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

1001 W Southlake Blvd
Southlake, TX 76092
Phone (817) 310-0421

731 E Southlake Blvd
Ste 100
Southlake, TX 76092
Phone (817) 424-3366

925 E Southlake Blvd
Ste 100
Southlake, TX 76092
Phone 2143582300 ext. 6225

Interoperability endpoints

  • Direct secure messaging: ezwernemann224852@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1427079300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-912-8800",
            "fax_number": "817-912-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-912-8800",
            "fax_number": "817-912-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZWERNEMANN",
        "first_name": "ERICA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-23",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L0731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045546102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "85496X",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045546101",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ezwernemann224852@direct.sw.org",
            "affiliation": "N",
            "address_1": "925 E Southlake Blvd Ste 100",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760921477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.