Arc Serenity Service

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ARC SERENITY SERVICE

Practice address

13521 Montfort Dr
Dallas, TX 75240-5120

Phone

(214) 302-7171

Fax

(657) 213-2652

NPI assigned

Sep 5, 2022

Organization subpart

No

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

Authorized official

Name

Jebeh Baimba, CRNPNPI 1144799834

Title

Owner

Phone

(832) 677-7015

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Jebeh Baimba

  • Family Nurse Practitioner
  • Lanham, MD
  • NPI 1144799834

  TX

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1662336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662336000000",
    "number": "1659092096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13521 MONTFORT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752405120",
            "telephone_number": "214-302-7171",
            "fax_number": "657-213-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13521 MONTFORT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752405120",
            "telephone_number": "214-302-7171",
            "fax_number": "657-213-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARC SERENITY SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-05",
        "last_updated": "2022-09-05",
        "certification_date": "2022-09-05",
        "status": "A",
        "authorized_official_last_name": "BAIMBA",
        "authorized_official_first_name": "JEBEH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-677-7015",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1075618",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.