NPIMap

Organization Active NPI

Modern Medical House Calls PLLC

  • General Practice Physician
  • Southlake, TX
National Provider Identifier
1043635931
Registry record updated Dec 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MODERN MEDICAL HOUSE CALLS PLLC
Practice address
855 Davis Blvd Ste 500
Southlake, TX 76092-8218
Phone
(817) 912-1771
Fax
(940) 241-6156
NPI assigned
Feb 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2019

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

Authorized official

Name
Mr. Salim Damji
Title
Owner
Phone
(818) 429-7860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

855 Davis Blvd Ste 500
Southlake, TX 76092-8218

Mailing address

855 Davis Blvd Ste 500
Southlake, TX 76092-8218
Phone (818) 429-7860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140815001827 TX Part B Supplier - Clinic/Group Practice 5092932921 Receives reassigned benefits from 18 practitioners
Practice locations: Southlake, TX

National Provider Directory

National Provider Directory

Locations

808 Schoolhouse Rd
Ste 114
Haslet, TX 76052
Phone (940) 648-8191

855 Davis Blvd
Ste 500
Southlake, TX 76092
Phone (817) 912-1771

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1393545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1043635931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 DAVIS BLVD STE 500",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928218",
            "telephone_number": "818-429-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 DAVIS BLVD STE 500",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928218",
            "telephone_number": "817-912-1771",
            "fax_number": "940-241-6156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MEDICAL HOUSE CALLS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-28",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "DAMJI",
        "authorized_official_first_name": "SALIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-429-7860",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.