Prime MD Geriatrics, PLLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

PRIME MD GERIATRICS, PLLC

Practice address

452 State Highway 121 Unit 130
Coppell, TX 75019-4275

Phone

(972) 393-1699

Fax

(972) 393-1702

NPI assigned

Mar 7, 2018

Organization subpart

No

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

Authorized official

Name

Divyaswapnika JavvajiNPI 1003176975

Title

Manager

Phone

(972) 393-1699

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Divyaswapnika Javvaji, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Coppell, TX
  • NPI 1003176975
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1487156139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "452 STATE HIGHWAY 121 UNIT 130",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194275",
            "telephone_number": "972-393-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 STATE HIGHWAY 121 UNIT 130",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194275",
            "telephone_number": "972-393-1699",
            "fax_number": "972-393-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MD GERIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "JAVVAJI",
        "authorized_official_first_name": "DIVYASWAPNIKA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-393-1699"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ambalakshmy Prabhakar
• Prachi Deore P.a.
• Precision Spine & Sport LLC
• Premier Aesthetic Surgicenter LLC
• Primary Health Inc Dba Carenow
• Principal Homecare
• PRN Services, Inc.
• Shannon Profanchik
• Prohealth
• Elise Elaine Pruett, D.D.S.

• Geriatric Medicine (Internal Medicine) Physician in Coppell, TX
• Providers in Coppell, TX by specialty
• Geriatric Medicine (Internal Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; 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.