NPI |
1760430219 |
|
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
DEUBER |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Name |
CHRISTINA |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
G |
The first name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
DR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Credential Text |
MD |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Line Business Practice Location Address |
5470 W. LOVERS LANE STE 330 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
DALLAS |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
TX |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
75209 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2149567337 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
4693648724 |
The date that a record was last updated or changed. |
Provider Enumeration Date |
5/5/2006 |
The code designating the provider’s gender if the provider is a person. |
Last Update Date |
7/9/2012 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Gender Code |
F |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Taxonomy Code 1 |
208000000X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider License Number 1 |
K0713 |
|
Provider License Number State Code 1 |
TX |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
050622563 TIN PLLC |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
TX |
|
Other Provider Identifier Issuer 1 |
WESTCHESTER PEDIATRICS |
|
Other Provider Identifier 2 |
K0713 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 2 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 2 |
TX |
|
Other Provider Identifier Issuer 2 |
MEDICL LICENSE |
|
Other Provider Identifier 3 |
752660211 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 3 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 3 |
TX |
|
Other Provider Identifier Issuer 3 |
TAXPAYOR NUMBER |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |