Organization Active NPI

Dino Pediatrics PLLC

  • Pediatrics Physician
  • Glen Rose, TX
National Provider Identifier
1942068077
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
DINO PEDIATRICS PLLC
Practice address
854 SW Big Bend Trail
Glen Rose, TX 76043-7604
Phone
(254) 635-6236
NPI assigned
Mar 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2025

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

Authorized official

Name
Christie Ramirez, NURSE PRACTITIONERNPI 1548412018
Title
Owner
Phone
(254) 635-6236

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

854 SW Big Bend Trail
Glen Rose, TX 76043-7604

Mailing address

2450 County Road 2027
Glen Rose, TX 76043-1360
Phone (817) 675-5891

Other practice location 1

1613 NE Big Bend Trl Ste C
Glen Rose, TX 76043-5036
Phone (254) 635-6236

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240517003561 TX Part B Supplier - Clinic/Group Practice 7012358252 Receives reassigned benefits from 1 practitioner
Practice locations: Glen Rose, 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
45D2301266Dino Pediatrics, PLLC854 SW Big Bend TRL, Glen Rose, TX 76043Certificate of waiverMar 21, 2028

National Provider Directory

National Provider Directory

Locations

854 SW Big Bend Trl
Glen Rose, TX 76043
Phone (254) 635-6236

1613 NE Big Bend Trl
Unit C
Glen Rose, TX 76043
Phone (254) 635-6236

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1942068077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 COUNTY ROAD 2027",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760431360",
            "telephone_number": "817-675-5891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "854 SW BIG BEND TRAIL",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760437604",
            "telephone_number": "254-635-6236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 NE Big Bend Trl Ste C",
            "address_purpose": "LOCATION",
            "city": "Glen Rose",
            "state": "TX",
            "postal_code": "760435036",
            "country_code": "US",
            "telephone_number": "254-635-6236",
            "fax_number": "740-212-8735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DINO PEDIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-12",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "RAMIREZ",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "254-635-6236",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Rose, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; 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.