Individual provider Active NPI

Stephanie Nichole Perez-Montelongo, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1558991836
Registry record updated Feb 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP143895 Issued in TX
Practice address
5323 Harry Hines Blvd
Dallas, TX 75390-7201
Phone
(214) 633-0908
NPI assigned
Jan 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP143895 TX
Acute Care Nurse Practitioner 363LA2100X AP143895 TX Primary

Addresses

Primary practice location

5323 Harry Hines Blvd
Dallas, TX 75390-7201

Mailing address

519 Harvest Glen Dr
Richardson, TX 75081-5606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229000348 TX Practitioner - Nurse Practitioner 3173973492 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP143895TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Nov 15, 2023 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Nov 15, 2023 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

6201 Harry Hines Blvd
Rm 4243
Dallas, TX 75235

6201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 633-4700

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1579910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1558991836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 HARVEST GLEN DR",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750815606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753907201",
            "telephone_number": "214-633-0908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ-MONTELONGO",
        "first_name": "STEPHANIE",
        "middle_name": "NICHOLE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-25",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP143895",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP143895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.