NPIMap

Organization Active NPI

United Dermatology Associates of Burleson, PLLC

  • Dermatology Physician
  • Burleson, TX
National Provider Identifier
1457778474
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
M1144 Issued in TX
Legal business name
UNITED DERMATOLOGY ASSOCIATES OF BURLESON, PLLC
Practice address
780 NE Alsbury Blvd
Suite B
Burleson, TX 76028-2641
Phone
(817) 261-1122
Fax
(817) 261-1123
NPI assigned
Mar 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Authorized official

Name
Mrs. Erica Barron
Title
Practice Manager
Phone
(817) 261-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X M1144 TX Primary

Addresses

Primary practice location

780 NE Alsbury Blvd
Suite B
Burleson, TX 76028-2641

Mailing address

2800 E Broad St
Suite 124
Mansfield, TX 76063-6410
Phone (817) 261-1122

Other names 1

  • Jeannine Hoang, MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140716001571 TX Part B Supplier - Clinic/Group Practice 8628294220 Receives reassigned benefits from 16 practitioners
Practice locations: Burleson, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1457778474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 E BROAD ST",
            "address_2": "SUITE 124",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636410",
            "telephone_number": "817-261-1122",
            "fax_number": "817-261-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 NE ALSBURY BLVD",
            "address_2": "SUITE B",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760282641",
            "telephone_number": "817-261-1122",
            "fax_number": "817-261-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED DERMATOLOGY ASSOCIATES OF BURLESON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "BARRON",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "817-261-1122",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M1144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeannine Hoang, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burleson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; 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.