NPIMap

Organization Active NPI

Pediplace

  • Pediatric Nurse Practitioner
  • Lewisville, TX
National Provider Identifier
1467573311
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
Legal business name
PEDIPLACE
Practice address
502 S Old Orchard LN Ste 126
Lewisville, TX 75067-4374
Phone
(972) 436-7962
Fax
(972) 353-5780
NPI assigned
Apr 2, 2007
Last updated
Jul 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Larry Robins
Title
Executive Director
Phone
(972) 436-7962

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU Primary
Specialist 174400000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

502 S Old Orchard LN Ste 126
Lewisville, TX 75067-4374

Mailing address

502 S Old Orchard LN Ste 126
Lewisville, TX 75067-4374
Phone (972) 436-7962

Other identifiers 2

IdentifierTypeStateIssuer
091930002MedicaidTX
091930001MedicaidTX

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
45D0952487Pediplace502 South Old Orchard Suite 126, Lewisville, TX 75067Certificate of waiverSep 21, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pediplace2 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

400 High School Dr
Lewisville, TX 75057
Phone (469) 713-5976

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1467573311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S OLD ORCHARD LN STE 126",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750674374",
            "telephone_number": "972-436-7962",
            "fax_number": "972-353-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S OLD ORCHARD LN STE 126",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750674374",
            "telephone_number": "972-436-7962",
            "fax_number": "972-353-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIPLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "ROBINS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "972-436-7962"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091930002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091930001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.