Organization Active NPI

DFW Primary Care PLLC

Doing business as DFW Geriatrics PLLC

  • Internal Medicine Physician
  • Irving, TX
National Provider Identifier
1063835361
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DFW PRIMARY CARE PLLC
Doing business as
DFW Geriatrics PLLC
Practice address
2925 Skyway Cir N
Irving, TX 75038-3510
Phone
(972) 639-5838
Fax
(972) 791-8211
NPI assigned
Jan 23, 2014
Last updated
Feb 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Dr. Sumana Ketha, MDNPI 1962447805
Title
President
Phone
(972) 639-5838

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
In Home Supportive Care Agency 253Z00000X TX

Addresses

Primary practice location

2925 Skyway Cir N
Irving, TX 75038-3510

Mailing address

2925 Skyway Cir N
Irving, TX 75038-3510
Phone (972) 639-5838

Other names 1

  • DFW Geriatrics PLLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140501000314 TX Part B Supplier - Clinic/Group Practice 8628201498 Receives reassigned benefits from 4 practitioners
Practice locations: Irving, TX; Dallas, TX; Grand Priarie, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2273088DFW Primary Care, PLLC2925 Skyway Circle North Suite 101, Irving, TX 75038Certificate of waiverDec 5, 2026

National Provider Directory

National Provider Directory

Locations

6161 Harry Hines Blvd
Ste 110
Dallas, TX 75235
Phone (214) 525-0623

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1063835361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 SKYWAY CIR N",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383510",
            "telephone_number": "972-639-5838",
            "fax_number": "972-791-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 SKYWAY CIR N",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383510",
            "telephone_number": "972-639-5838",
            "fax_number": "972-791-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DFW PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "KETHA",
        "authorized_official_first_name": "SUMANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-639-5838",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DFW Geriatrics PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.