| NPI Number | 1831203207 |
| Provider Name | Andrea Vernell Brown |
| Credential | |
| Specialization | |
| Medical School Name | Michigan State University College Of Human Medicine |
| Graduation Year | 1983 |
| Gender | F |
| Entity Type | Individual |
| PAC ID by PECOS | 7517054133 |
| Professional Enrollment ID | I20120305000595 |
| Enumeration Date | 08/19/2006 |
| Last Update Date | 03/15/2011 |
| Business Practice address |
526 E PLEASANT RUN RD, Desoto, 75115-4019 Texas View on Google Map |
| Business Practice phone | 972-223-4420 |
| Business Practice fax | 972-274-1167 |
| Mailing address |
526 E. PLEASANT RUN RD, Desoto, 75115-4019 Texas View on Google Map |
| Other phone | 972-223-4420 |
| Other fax | 972-274-1167 |
| Email Address | shannonfig@domain.com Reval Email Address |
Methodist Charlton Medical Center in Desoto
Desoto, Texas
Michigan State University College Of Human Medicine
1983
| Organization Name | PECOS PAC ID | Members | |
|---|---|---|---|
|
Wellmed Medical Group Pa | 4880657386 | 665 |
| Field Name | Field Value |
|---|---|
| NPI | 1831203207 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
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| Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
|
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| Provider Last Name (Legal Name) | Brown |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Andrea |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | M.D. |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | 526 E. PLEASANT RUN RD |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Desoto |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Texas |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 75115-4019 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 972-223-4420 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider Business Mailing Address Fax Number | 972-274-1167 |
| The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''. | |
| Provider First Line Business Practice Location Address | 526 E PLEASANT RUN RD |
| 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 | Desoto |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Texas |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 75115-4019 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 972-223-4420 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Business Practice Location Address Fax Number | 972-274-1167 |
| The fax number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 08/19/2006 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 03/15/2011 |
| The date that a record was last updated or changed. | |
| Provider Gender Code | F |
| The code designating the provider's gender if the provider is a person. | |
| Provider Gender | Female |
| The provider's gender if the provider is a person. | |
| Healthcare Provider Taxonomy Code #1 | 302F00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | (1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations. |
| Healthcare Provider Taxonomy #1 | |
| Provider License Number 1 | K1779 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 1 | TX |
| Provider License Number State Code #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 302R00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | (1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model. |
| Healthcare Provider Taxonomy #2 | |
| Provider License Number 2 | K1779 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 2 | TX |
| Provider License Number State Code #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 305R00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Healthcare Provider Taxonomy #3 | |
| Provider License Number 3 | K1779 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 3 | TX |
| Provider License Number State Code #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 305S00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Healthcare Provider Taxonomy #4 | |
| Provider License Number 4 | K1779 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 4 | TX |
| Provider License Number State Code #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #5 | 207Q00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Healthcare Provider Taxonomy #5 | |
| Provider License Number 5 | K1779 |
| Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
| Provider License Number State Code 5 | TX |
| Provider License Number State Code #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | Y |
Primary Taxonomy:
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