Basic Information
| Provider Information | |||||||||
| NPI: | 1649377359 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEDIATRIX MEDICAL GROUP OF TEXAS BILLING, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 CONCORD TER | ||||||||
| Address2: | |||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543840175 | ||||||||
| FaxNumber: | 9548511948 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 E PRESIDENT GEORGE BUSH HWY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750823542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724375099 | ||||||||
| FaxNumber: | 9727641661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DWYER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9543840175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PEDIATRIX MEDICAL SERVICES INC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0098JQ | 01 | TX | BCBS | OTHER | 00U99U | 01 | TX | BCBS | OTHER | 137308614 | 05 | TX | MEDICAID | 137308637 | 05 | TX | MEDICAID | 141686903 | 05 | TX | MEDICAID | 141691904 | 05 | TX | MEDICAID | 141691914 | 05 | TX | MEDICAID | 178099101 | 05 | TX | MEDICAID | 289221213A | 05 | TX | MEDICAID | 8206898 | 01 | TX | AETNA | OTHER | 0084A | 01 | MEDICARE | OTHER | 0084AZ | 01 | TX | MEDICARE | OTHER | 137308612 | 05 | TX | MEDICAID | 137308617 | 05 | TX | MEDICAID | 137308620 | 05 | TX | MEDICAID | 137308631 | 05 | TX | MEDICAID | 137308633 | 05 | TX | MEDICAID | 141691901 | 05 | TX | MEDICAID | 141691908 | 05 | TX | MEDICAID | 141691909 | 05 | TX | MEDICAID | 144542103 | 05 | TX | MEDICAID | 184048701 | 05 | TX | MEDICAID | 00059H | 01 | TX | BCBS | OTHER | 0067GW | 01 | TX | BCBS | OTHER | 00R66Z | 01 | TX | MEDICARE | OTHER | 137308623 | 05 | TX | MEDICAID | 141691906 | 05 | TX | MEDICAID | 141691910 | 05 | TX | MEDICAID | 95656049 | 05 | TX | MEDICAID | 0084AZ | 01 | TX | BCBS | OTHER | 137308621 | 05 | TX | MEDICAID | 141606701 | 05 | TX | MEDICAID | 141691903 | 05 | TX | MEDICAID | 144542102 | 05 | TX | MEDICAID | 137308619 | 05 | TX | MEDICAID | 141691911 | 05 | TX | MEDICAID | 187119601 | 05 | TX | MEDICAID | 0055BR | 01 | TX | BCBS | OTHER | 141611701 | 05 | TX | MEDICAID | 144542104 | 05 | TX | MEDICAID | 177999301 | 05 | TX | MEDICAID | 184818601 | 05 | TX | MEDICAID | 529907870 | 05 | TX | MEDICAID | 00059H | 01 | TX | MEDICARE | OTHER | 00186R | 01 | TX | BCBS | OTHER | 0055BR | 01 | TX | MEDICARE | OTHER | 144542105 | 05 | TX | MEDICAID | 169372301 | 05 | TX | MEDICAID | 529908050 | 05 | TX | MEDICAID | Z000U99U2 | 01 | TX | MEDICARE | OTHER |