DESIREE BUEHLER PENDERGRASS M.D. NPI 1255425989

NPI Information

NPI: 1255425989
Provider Name: DESIREE BUEHLER PENDERGRASS, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual

PECOS Registration: Yes

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 815-8982
Get Directions

Desiree Buehler Pendergrass, M.D. is a pediatrics in Jackson, MS. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Desiree Buehler Pendergrass, M.D. NPI is 1255425989. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 815-8982

The NPI 1255425989 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 2/17/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		24712	MISSISSIPPI	Yes
2	208000000X	Pediatrics		H4609	TEXAS	No
3	2083P0901X	Preventive Medicine	Public Health & General Preventive Medicine	24712	MISSISSIPPI	No
4	2083P0901X	Preventive Medicine	Public Health & General Preventive Medicine	H4609	TEXAS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	08907561	OTHER	TEXAS	NM MEDICAID
2	551694YJ5D	MEDICARE PIN	MISSISSIPPI
3	132232307	OTHER	TEXAS	TMHP
4	8J1510	OTHER	TEXAS	MEDICARE
5	8G6058	OTHER	TEXAS	BC/BS
6	155349101	OTHER	TEXAS	FIRSTCARE MEDICAID
7	05359595	MEDICAID	MISSISSIPPI
8	200101350A	OTHER	TEXAS	OK MEDICARE
9	E52071	MEDICARE UPIN	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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