Active NPI
Mimi Van Der Leden, M.D.
- Family Medicine Physician
- Spring, TX
National Provider Identifier
1932166741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- L1227
- Practice address
- 18425 Champion Forest Dr
Spring, TX 77379-3999 - Phone
- (281) 376-4410
- Fax
- (281) 251-7505
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L1227 | TX | Primary |
Addresses
Primary practice location
18425 Champion Forest Dr
Spring, TX 77379-3999
Mailing address
PO Box 3397
Oak Park, IL 60303-3397
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0045JQ | Other | TX | BCBS# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L1227 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373328000000",
"number": "1932166741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3397",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603033397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18425 CHAMPION FOREST DR",
"city": "SPRING",
"state": "TX",
"postal_code": "773793999",
"telephone_number": "281-376-4410",
"fax_number": "281-251-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DER LEDEN",
"first_name": "MIMI",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2013-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "L1227",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS#",
"identifier": "0045JQ",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.