Individual provider Active NPI

Erika Lychunn Runnels, D.D.S.

  • Dentist
  • Houston, TX
National Provider Identifier
1609064005
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
25150 Issued in TX
Practice address
5600 S Willow Dr Ste 111
Houston, TX 77035-4721
Phone
(713) 497-5152
NPI assigned
Oct 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 25150 TX Primary

Addresses

Primary practice location

5600 S Willow Dr Ste 111
Houston, TX 77035-4721

Mailing address

5600 S Willow Dr Ste 111
Houston, TX 77035-4721
Phone (713) 497-5152

Other identifiers 1

IdentifierTypeStateIssuer
3265936MedicaidTX

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151210001849 TX Order and Referring Only - DentistPractitioner - Dentist 9537460860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25150TXMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424908800000",
    "number": "1609064005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 S WILLOW DR STE 111",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770354721",
            "telephone_number": "713-497-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 S WILLOW DR STE 111",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770354721",
            "telephone_number": "713-497-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNNELS",
        "first_name": "ERIKA",
        "middle_name": "LYCHUNN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-10",
        "last_updated": "2015-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "25150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3265936",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.