Individual provider Active NPI

Sandy Trevizo, DO

  • Family Medicine Physician
  • Mesquite, TX
National Provider Identifier
1023690153
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
V0563 Issued in TX
Practice address
3228 Interstate 30 Ste 200
Mesquite, TX 75150-2633
Phone
(972) 216-5400
Fax
(972) 216-5405
NPI assigned
Apr 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X V0563 TX Primary

Addresses

Primary practice location

3228 Interstate 30 Ste 200
Mesquite, TX 75150-2633

Mailing address

3228 Interstate 30 Ste 200
Mesquite, TX 75150-2633
Phone (972) 216-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240809003788 TX Practitioner - Family Practice 5597203430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

3228 Interstate 30
Suite 200
Mesquite, TX 75150-2633
Phone (972) 216-5400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
V0563TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Group, PA Family Medicine CurrentSince Sep 9, 2024 Accepting new patients
Wellmed Medical Group, P.a. Family Medicine CurrentSince Sep 9, 2024 Accepting new patients

Locations

3228 Interstate 30
Ste 200
Mesquite, TX 75150
Phone (972) 216-5400

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

Interoperability endpoints

  • Direct secure messaging: sandy.trevizo@wellmed.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1023690153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3228 INTERSTATE 30 STE 200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502633",
            "telephone_number": "972-216-5400",
            "fax_number": "972-216-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3228 INTERSTATE 30 STE 200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751502633",
            "telephone_number": "972-216-5400",
            "fax_number": "972-216-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREVIZO",
        "first_name": "SANDY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-27",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "V0563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, TX

Sources for this page

Verify at the official NPI Registry.