NPIMap

Organization Active NPI

Peds Center of Round Rock PA

  • Pediatrics Physician
  • Georgetown, TX
National Provider Identifier
1508370701
Registry record updated Nov 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDS CENTER OF ROUND ROCK PA
Practice address
1526 Leander Rd
Georgetown, TX 78628-8801
Phone
(512) 863-7586
Fax
(512) 863-5222
NPI assigned
Nov 27, 2017
Organization subpart
Yes
Parent organization
PEDS CENTER OF ROUND ROCK PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2017

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

Authorized official

Name
Vivekananda Dasari, M.D.
Title
Owner
Phone
(201) 289-7621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1526 Leander Rd
Georgetown, TX 78628-8801

Mailing address

1526 Leander Rd
Georgetown, TX 78628-8801
Phone (512) 863-7586

Other names 1

  • River Ridge Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Center of Round Rock8 organizations share this tax ID, including this one
Part of
Pediatric Center of Round Rock

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511740800000",
    "number": "1508370701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288801",
            "telephone_number": "512-863-7586",
            "fax_number": "512-863-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 LEANDER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288801",
            "telephone_number": "512-863-7586",
            "fax_number": "512-863-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDS CENTER OF ROUND ROCK PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDS CENTER OF ROUND ROCK PA",
        "enumeration_date": "2017-11-27",
        "last_updated": "2017-11-27",
        "status": "A",
        "authorized_official_last_name": "DASARI",
        "authorized_official_first_name": "VIVEKANANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-289-7621",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Ridge Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.