Kathleen Marie Pedersen, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

Q9000 Issued in TX

Practice address

1111 W Airport Fwy
Suite 143
Irving, TX 75062-6203

Phone

(469) 488-4500

NPI assigned

May 1, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpedersen83792@direct.phhs.org

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.

• Dallas County Hospital District

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1649278995
  Medicare reassignment
• Dallas County Hospital District

  • Nurse Practitioner
  • Irving, TX
  • NPI 1326296617
  NPD
• Dallas County Hospital District

  • Women's Health Nurse Practitioner
  • Dallas, TX
  • NPI 1558035188
  NPD
• Dallas County Hospital District

  • Women's Health Nurse Practitioner
  • Dallas, TX
  • NPI 1831198506
  NPD

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468022400000",
    "number": "1700221918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 W AIRPORT FWY",
            "address_2": "SUITE 143",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750626203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W AIRPORT FWY",
            "address_2": "SUITE 143",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750626203",
            "telephone_number": "469-488-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-01",
        "last_updated": "2016-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q9000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peaceful Living Home Healthcare LLC
• Peach Tree Dental
• H Stuart Peake, M.D.
• Carl Wesley Pearce, LPC, LMSW
• Kaitlin Peatross
• Pediatria Healthcare, LLC
• Pediatric Dental Associates of Las Colinas
• Pediatric Diagnostic Services, PA
• Pediatric Eyecare of North Texas, PLLC
• Pediatric Health Specialists, Inc

• Pediatrics Physician in Irving, TX
• Providers in Irving, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.