Individual provider Active NPI

Rebecca Blossom Neander, RN, CPNP

  • Primary Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1689937419
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP110428 Issued in TX
Practice address
1300 W Lancaster Ave Ste 205
Fort Worth, TX 76102-3490
Phone
(817) 336-8611
Fax
(817) 390-2981
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP110428 TX
Primary Care Nurse Practitioner 363LP2300X AP110428 TX Primary

Addresses

Primary practice location

1300 W Lancaster Ave Ste 205
Fort Worth, TX 76102-3490

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-1855

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rneander15838@CookChildrens.direct-ci.com

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
I20140626002598 TX Practitioner - Nurse Practitioner 5799900106 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
AP110428TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Scottish Rite Hospital for Crippled Children CurrentSince Mar 4, 2014 Accepting new patients
Cook Children's Medical Center PastSince Apr 20, 2021 Accepting new patients

Locations

2222 Welborn St
Dallas, TX 75219
Phone (214) 559-5000

3800 Gaylord Pkwy
Ste 850
Frisco, TX 75034
Phone (469) 857-2222

Interoperability endpoints

  • Direct secure messaging: rneander15838@cookchildrens.direct-ci.com

Organizations & group practices 2

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1689937419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W LANCASTER AVE STE 205",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761023490",
            "telephone_number": "817-336-8611",
            "fax_number": "817-390-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEANDER",
        "first_name": "REBECCA",
        "middle_name": "BLOSSOM",
        "name_prefix": "Mrs.",
        "credential": "RN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP110428",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP110428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rneander15838@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "1300 W Lancaster Ave Ste 205",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761023490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.