NPIMap

Organization Active NPI

Kidsville Pediatrics PLLC

  • Pediatric Critical Care Medicine Physician
  • Mansfield, TX
National Provider Identifier
1689264996
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
Legal business name
KIDSVILLE PEDIATRICS PLLC
Practice address
1759 Broad Park Cir S
Mansfield, TX 76063-7833
Phone
(682) 341-3888
Fax
(682) 400-1288
NPI assigned
Jan 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Authorized official

Name
Tarek Salman, MDNPI 1205263340
Title
Manager
Phone
(682) 341-3888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Critical Care Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0203X Primary
Pulmonary Function Technologist Certified Respiratory TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2278P1006X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1759 Broad Park Cir S
Mansfield, TX 76063-7833

Mailing address

1759 Broad Park Cir S
Mansfield, TX 76063-7833
Phone (682) 341-3888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260306001107 TX Part B Supplier - Clinic/Group Practice 8325520448 Receives reassigned benefits from 8 practitioners
Practice locations: Mansfield, TX; McKinney, TX; Southlake, TX

National Provider Directory

National Provider Directory

Locations

1759 Broad Park Cir S
Ste Odd
Mansfield, TX 76063

1759 Broad Park Cir S
Mansfield, TX 76063
Phone (682) 341-3888

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1689264996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637833",
            "telephone_number": "682-341-3888",
            "fax_number": "682-400-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637833",
            "telephone_number": "682-341-3888",
            "fax_number": "682-400-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSVILLE PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "SALMAN",
        "authorized_official_first_name": "TAREK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "682-341-3888",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2278P1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Respiratory Therapist, Certified, Pulmonary Function Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.