Active NPI
Nicholas Quang Pham, DO
- Student in an Organized Health Care Education/Training Program
- Dallas, TX
National Provider Identifier
1992559363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- BP10089119
- Practice address
- 1441 N Beckley Ave
Dallas, TX 75203-1201 - Phone
- (214) 947-2306
- NPI assigned
- Apr 12, 2024
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | BP10089119 | TX | Primary |
Addresses
Primary practice location
1441 N Beckley Ave
Dallas, TX 75203-1201
Mailing address
5528 Lavaca Rd
Grand Prairie, TX 75052-8566
Phone (469) 928-5714
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240618001012 | TX | Order and Referring Only - Internal Medicine | 8022551142 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP10089119 | TX | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712880000000",
"number": "1992559363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5528 LAVACA RD",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750528566",
"telephone_number": "469-928-5714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1441 N BECKLEY AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752031201",
"telephone_number": "214-947-2306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "NICHOLAS",
"middle_name": "QUANG",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-12",
"last_updated": "2024-04-12",
"certification_date": "2024-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "BP10089119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.