Organization Active NPI

Coppell Associates in Family Medicine PA

  • Family Medicine Physician
  • Coppell, TX
National Provider Identifier
1447386966
Registry record updated Jun 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G6149 Issued in TX
Legal business name
COPPELL ASSOCIATES IN FAMILY MEDICINE PA
Practice address
848 S Denton Tap Rd
Suite 100
Coppell, TX 75019-4558
Phone
(972) 393-5559
Fax
(972) 393-5479
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2014

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

Authorized official

Name
Danielle Roberts
Title
Office Staff
Phone
(972) 393-5559

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X G6149 TX Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA02895 TX

Addresses

Primary practice location

848 S Denton Tap Rd
Suite 100
Coppell, TX 75019-4558

Mailing address

848 S Denton Tap Rd
Suite 100
Coppell, TX 75019-4558
Phone (972) 393-5559

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070611000458 TX Part B Supplier - Clinic/Group Practice 1153429451 Receives reassigned benefits from 1 practitioner
Practice locations: Coppell, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2070969Coppell Associates in Family Medicine848 S Denton Tap #100, Coppell, TX 75019Certificate of waiverDec 29, 2027

National Provider Directory

National Provider Directory

Locations

848 S Denton Tap Rd
Ste 100
Coppell, TX 75019
Phone (972) 393-5559

Practitioners & affiliated clinicians

Practitioners 1

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": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1447386966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 S DENTON TAP RD",
            "address_2": "SUITE 100",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194558",
            "telephone_number": "972-393-5559",
            "fax_number": "972-393-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 S DENTON TAP RD",
            "address_2": "SUITE 100",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194558",
            "telephone_number": "972-393-5559",
            "fax_number": "972-393-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPELL ASSOCIATES IN FAMILY MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "OFFICE STAFF",
        "authorized_official_telephone_number": "972-393-5559"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G6149",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02895",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coppell, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.