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PRIME MD GERIATRICS, PLLC
NPI 1487156139
Internal Medicine - Geriatric Medicine in Coppell, TX

Active since March 07, 2018CLIA 45D2172483 · Waiver
452 STATE HIGHWAY 121 UNIT 130, COPPELL, TX 75019(972) 393-1699(972) 393-1702 Get Directions Write a Review

NPPES record last updated: June 7, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 7, 2024, Jul 17, 2019, May 14, 2019 and 4 more (7 updates tracked since 2018).

About Prime Md Geriatrics, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIME MD GERIATRICS, PLLC (NPI 1487156139) is a healthcare organization registered as a geriatric medicine in Coppell, Texas and active in the NPI registry since March 2018. The organization holds a CLIA Waiver certificate valid through September 23, 2027 and lists Divyaswapnika Javvaji, Manager, as its authorized official.

NPPES Registry Identity

NPI1487156139
Entity TypeOrganization
Primary Taxonomy207RG0300X
Legal Business NamePRIME MD GERIATRICS, PLLC
Location Address452 STATE HIGHWAY 121 UNIT 130Coppell, TX 75019-4275
Mailing Address452 State Highway 121 Unit 130Coppell, TX 75019-4275 · (972) 393-1699
Phone(972) 393-1699
Fax(972) 393-1702
Organization SubpartNo
Authorized OfficialDivyaswapnika JavvajiManager · (972) 393-1699
Enumeration DateMarch 7, 2018
Last NPPES UpdateJune 7, 20247 updates tracked since enumeration
NPPES CertifiedJune 7, 2024
✔ NPI 1487156139 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RG0300X
Definition
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.
452 STATE HIGHWAY 121 UNIT 130, Coppell, TX 75019
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2172483

Prime MD Geriatrics · Coppell, TX
Active · expires Sep 23, 2027
CLIA Number45D2172483
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2025
Certificate Expiration DateSeptember 23, 2027
Laboratory DirectorNadelya S. Kinnon
Laboratory Phone(972) 393-1699
Laboratory LocationPrime MD Geriatrics452 State Highway 121 Suite 130, Coppell, TX 75019
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIVYASWAPNIKA JAVVAJI M.D
Internal Medicine (Geriatric Medicine)
452 STATE HIGHWAY 121 UNIT 130
COPPELL, TX 75019
Dallas County (972) 393-1699

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prime MD Geriatrics, PLLC's NPI number?

The NPI number for Prime MD Geriatrics, PLLC is 1487156139. It was assigned to this organization in the NPPES registry on March 7, 2018.

Where is Prime MD Geriatrics, PLLC located?

Prime MD Geriatrics, PLLC is located at 452 State Highway 121 Unit 130, Coppell, TX 75019. The listed phone number is (972) 393-1699.

What is Prime MD Geriatrics, PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Geriatric Medicine, with taxonomy code 207RG0300X.

Does Prime MD Geriatrics, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2172483) is associated with this NPI, valid through September 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prime MD Geriatrics, PLLC was last updated on June 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.