Organization Active NPI

Sailor Moon

  • Anesthesiology Physician
  • Richardson, TX
National Provider Identifier
1760946859
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SAILOR MOON
Practice address
2831 George Bush Hwy
Richardson, TX 75082-3561
Phone
(765) 284-0493
NPI assigned
Jan 23, 2019
Last updated
Jan 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Authorized official

Name
George Jones, MDNPI 1538193057
Title
Owner/Physician
Phone
(214) 850-6123

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

2831 George Bush Hwy
Richardson, TX 75082-3561

Mailing address

PO Box 41
Muncie, IN 47308-0041
Phone (765) 284-0493

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190603002198 TX Part B Supplier - Clinic/Group Practice 8123351335 Receives reassigned benefits from 1 practitioner
Practice locations: Richardson, TX; Frisco, TX; Plano, TX; Dallas, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579132800000",
    "number": "1760946859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473080041",
            "telephone_number": "765-284-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 GEORGE BUSH HWY",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750823561",
            "telephone_number": "765-284-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAILOR MOON",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "214-850-6123",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.