NPIMap

Organization Active NPI

The Pediatric Clinic, P.a.

Doing business as Pediatric Clinic Mount Pleasant

  • Rural Health Clinic/Center
  • Mount Pleasant, TX
National Provider Identifier
1437984259
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THE PEDIATRIC CLINIC, P.A.
Doing business as
Pediatric Clinic Mount Pleasant
Practice address
2001 N Jefferson Ave Ste 300
Mount Pleasant, TX 75455-2375
Phone
(903) 572-9823
Fax
(903) 572-4812
NPI assigned
Sep 3, 2024
Last updated
Sep 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Authorized official

Name
Suzan Colvin
Title
Administrtor
Phone
(903) 572-9823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2001 N Jefferson Ave Ste 300
Mount Pleasant, TX 75455-2375

Mailing address

2001 N Jefferson Ave Ste 300
Mount Pleasant, TX 75455-2375
Phone (903) 572-9823

Other names 1

  • Pediatric Clinic Mount Pleasant Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240919001723 TX Part A Provider - Rural Health Clinic 4880747534 Practice locations: Mount Pleasant, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437984259. Details of each certification follow.

Rural health clinic certification: CCN 678934

Legal name
THE PEDIATRIC CLINIC, P.A.
Doing business as
PEDIATRIC CLINIC MOUNT PLEASANT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 14, 2024
Last certification
Nov 14, 2024
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 25, 1981 in TX
Enrollment address
2001 N Jefferson Ave
Ste 300
Mount Pleasant, TX 75455-2375

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pediatric 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

2001 N Jefferson Ave
Ste 300
Mt Pleasant, TX 75455
Phone (903) 572-9823

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dana L Rice Individual 5% Or Greater Direct Ownership InterestOwner Feb 1, 2021 50%
Corporate OfficerOwner Feb 1, 2021 50%
Corporate DirectorOwner Feb 1, 2021 50%
W-2 Managing EmployeePartner Owner Feb 1, 2021 50%
Michael Henry Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2016 50%
Corporate OfficerOwner Jan 1, 2016 50%
Corporate DirectorOwner Jan 1, 2016 50%
W-2 Managing EmployeePartner Owner Jan 1, 2016 50%
Suzan C Colvin Individual W-2 Managing EmployeeAd; Sep 3, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Michael Henry, MD
    • Pediatrics Physician
    • Mount Pleasant, TX
    • NPI 1174841902

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Dana Lynn Rice, M.D.
    • Pediatrics Physician
    • Mount Pleasant, TX
    • NPI 1659392421

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 10

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": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757980800000",
    "number": "1437984259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 N JEFFERSON AVE STE 300",
            "city": "MOUNT PLEASANT",
            "state": "TX",
            "postal_code": "754552375",
            "telephone_number": "903-572-9823",
            "fax_number": "903-572-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 N JEFFERSON AVE STE 300",
            "city": "MOUNT PLEASANT",
            "state": "TX",
            "postal_code": "754552375",
            "telephone_number": "903-572-9823",
            "fax_number": "903-572-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-03",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A",
        "authorized_official_last_name": "COLVIN",
        "authorized_official_first_name": "SUZAN",
        "authorized_official_title_or_position": "ADMINISTRTOR",
        "authorized_official_telephone_number": "903-572-9823"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Clinic Mount Pleasant",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Clinic Mount Pleasant",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, TX

Sources for this page

Verify at the official NPI Registry.