Alexander Lee Pendergrass, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1003207 Issued in TX

Practice address

808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426-2061

Phone

(817) 966-2960

NPI assigned

Jul 16, 2020

Last updated

Jul 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Gulf Shoals PLLCGroup PAC ID 0648619833, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alexpendergrass@dardp-tx.direct.office.nextgen.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gulf Shoals PLLC

  • Family Medicine Physician
  • Flower Mound, TX
  • NPI 1497515894
  Medicare reassignment Care Compare group NPD
• Burnaby Medical Group LLC

  dba Burnaby Medical Group

  • Internal Medicine Physician
  • Colleyville, TX
  • NPI 1104510577
  Medicare reassignment NPD
• Ascend Medical Group PLLC

  dba Ascend Clinic

  • Family Medicine Physician
  • Flower Mound, TX
  • NPI 1669302113
  NPD

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1982212841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 RIVER LODGE TRL S APT 420",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160830",
            "telephone_number": "817-966-2960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 WOODROW WILSON RAY CIR",
            "city": "BRIDGEPORT",
            "state": "TX",
            "postal_code": "764262061",
            "telephone_number": "817-966-2960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "ALEXANDER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1003207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Sue Montgomery, CPHT
• Anna Leigh Morgan, LPC ASSOCIATE
• William Newsom
• Brenda Norwood
• Natalie Palacios, LCSW
• PMG Opco-Bridgeport LLC (The Residences at Senior Care)
• Kaye Puckett, DNP, FNP-BC
• David A. Ray, D.O.
• Rcast Partners
• Brian James Richard, PHARM.D

• Family Nurse Practitioner in Bridgeport, TX
• Providers in Bridgeport, TX by specialty
• Family Nurse Practitioner in Texas

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