Brianna Souder, DO

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

V2279 Issued in TX

Practice address

909 E SE Loop 323 Ste 360
Tyler, TX 75701-9101

Phone

(903) 393-3169

Fax

(903) 508-6154

NPI assigned

Mar 22, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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 Osteopathy

State licenses

Practice roles

Locations

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 Physician Medical Services for Children Inc

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1194153650
  Medicare reassignment NPD
• Dallas Physician Medical Services for Children Inc

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1558407908
  NPD
• Complex Care Medical Services Corporation

  • Pediatrics Physician
  • Dallas, TX
  • NPI 1013256098
  NPD (past)
• W Pennock Laird MD PA

  • Pediatric Cardiology Physician
  • Dallas, TX
  • NPI 1740353598

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1780115618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E SE LOOP 323 STE 360",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019101",
            "telephone_number": "903-393-3169",
            "fax_number": "903-508-6154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E SE LOOP 323 STE 360",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019101",
            "telephone_number": "903-393-3169",
            "fax_number": "903-508-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUDER",
        "first_name": "BRIANNA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2020-00828",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "TX",
            "license": "V2279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA MEDICAL BOARD",
            "identifier": "2020-00828",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "V2279",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sonowave Inc.
• Joeie Nichole Soria, RBT
• Suphaphorn Sornphet
• Glen W Sorrentino, MD
• Michael Anthony Sorto, M.D.
• South Limestone Hospital District
• South Limestone Hospital District
• South Park Care & Rehab LLC
• South Tyler Dermatology
• South Tyler Family Dentistry PLLC

• Pediatric Cardiology Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Pediatric Cardiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2024; 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.