Organization Active NPI

Primary Visiting Clinicians PLLC

Doing business as PVC Family Practice

  • Family Nurse Practitioner
  • Garland, TX
National Provider Identifier
1720468390
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP120628 Issued in TX
Legal business name
PRIMARY VISITING CLINICIANS PLLC
Doing business as
PVC Family Practice
Practice address
3334 Broadway Blvd Ste 422
Garland, TX 75043-1575
Phone
(972) 979-7408
Fax
(972) 587-6733
NPI assigned
Jun 9, 2015
Last updated
Oct 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Authorized official

Name
Mrs. Zainabu Koroma, FNPNPI 1699053553
Title
Administrator
Phone
(972) 979-7408

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP120628 TX Primary
Internal Medicine Physician 207R00000X L5507 TX

Addresses

Primary practice location

3334 Broadway Blvd Ste 422
Garland, TX 75043-1575

Mailing address

3334 Broadway Blvd Ste 422
Garland, TX 75043-1575
Phone (972) 979-7408

Other names 1

  • PVC Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150720000799 TX Part B Supplier - Clinic/Group Practice 2668785791 Receives reassigned benefits from 7 practitioners
Practice locations: Garland, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2125162Primary Visiting Clinicians, PLLC3334 Broadway Blvd Suite 422, Garland, TX 75043Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DFDCBD

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1720468390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 BROADWAY BLVD STE 422",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750431575",
            "telephone_number": "972-979-7408",
            "fax_number": "972-587-6733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 BROADWAY BLVD STE 422",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750431575",
            "telephone_number": "972-979-7408",
            "fax_number": "972-587-6733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY VISITING CLINICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "KOROMA",
        "authorized_official_first_name": "ZAINABU",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-979-7408",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP120628",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L5507",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PVC Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.