CCN: 675352 NPI: 1053700617 Organization

BRENTWOOD PLACE THREE

3505 S BUCKNER BLVD BLDG 4
DALLAS, TX 752275451

Contact Information

Phone 2143811815
Fax 2143814454
Enumeration Date 2015-01-20
Last Updated 2022-03-16

Taxonomies

Code: 314000000X (Primary)

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 0.9844187231

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 1.0

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 1.0

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 0.992

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 1.0

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 0.980278308

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 1.0

censusDivision 7

cbsaActualGeographicLocation 19124

providerType 38

caseMixIndex 1.0

vbpAdjustment 0.9874930982

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 19124

providerType 38

carrierCode 04412

localityCode 11

cbsaActualGeographicLocation 19124

providerType 38

specialPaymentIndicator

carrierCode 04412

localityCode 11

cbsaActualGeographicLocation 19124

providerType 38

specialPaymentIndicator

carrierCode 04412

localityCode 11

cbsaActualGeographicLocation 19124

providerType 38

specialPaymentIndicator

carrierCode 04412

localityCode 11

cbsaActualGeographicLocation 19124

providerType 38

specialPaymentIndicator 1

carrierCode 04412

localityCode 11