Organization Active NPI

Rajesh B Vrushab MD PLLC

  • Clinical Cardiac Electrophysiology Physician
  • Bedford, TX
National Provider Identifier
1871866111
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
M3106 Issued in TX
Legal business name
RAJESH B VRUSHAB MD PLLC
Practice address
1305 Airport Fwy
Ste 424
Bedford, TX 76021-6605
Phone
(817) 545-1355
NPI assigned
Feb 16, 2012
Last updated
Mar 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Mrs. Stacy Lee Reeves
Title
Office Manager
Phone
(817) 428-1865

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Cardiac Electrophysiology Physician 207RC0001X M3106 TX Primary

Addresses

Primary practice location

1305 Airport Fwy
Ste 424
Bedford, TX 76021-6605

Mailing address

1615 Precinct Line Rd Ste 103
Hurst, TX 76054-3345
Phone (817) 428-1865

Other identifiers 1

IdentifierTypeStateIssuer
308761101MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120608000213 TX Part B Supplier - Clinic/Group Practice 7012171796 Receives reassigned benefits from 1 practitioner
Practice locations: Bedford, 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
45D2038856Rajesh B Vrushab MD PLLC1305 Airport Freeway Suite 424, Bedford, TX 76021Certificate of waiverMar 26, 2028

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": "1329350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1871866111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 PRECINCT LINE RD STE 103",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543345",
            "telephone_number": "817-428-1865",
            "fax_number": "817-281-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 AIRPORT FWY",
            "address_2": "STE 424",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760216605",
            "telephone_number": "817-545-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAJESH B VRUSHAB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-16",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "817-428-1865",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "TX",
            "license": "M3106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "308761101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; 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.