Individual provider Active NPI

Andrew Sadousky, MS, FNP-C

  • Family Nurse Practitioner
  • Southlake, TX
National Provider Identifier
1063893378
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP127302 Issued in TX
Practice address
250 Miron Dr
Southlake, TX 76092-7852
Phone
(817) 328-3000
NPI assigned
Jun 11, 2015
Last updated
Oct 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP127302 TX Primary

Addresses

Primary practice location

250 Miron Dr
Southlake, TX 76092-7852

Mailing address

2630 Villa Di Lago
Unit 3
Grand Prairie, TX 75054-6622

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240920002177 TX Practitioner - Nurse Practitioner 1759822406 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Global Open Wound Care PLLCGroup PAC ID 8921475294, 14 clinicians

Practice addresses (Care Compare)

Southlake, TX 76092
Phone (817) 328-3000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP127302TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Global Open Wound Care PLLC Family CurrentSince Aug 1, 2024 Accepting new patients
Verdure Health Services CurrentSince Jan 9, 2026 Accepting new patients
Global Open Wound Care Services LLC Family CurrentSince Jan 26, 2025 Accepting new patients

Locations

8270 Woodland Center Blvd
Ste 121
Tampa, FL 33614
Phone (817) 328-3000

5900 Balcones Dr
Ste 100
Austin, TX 78731

105 Decker Ct
Ste 140
Irving, TX 75062
Phone (210) 201-4546

250 Miron Dr
Southlake, TX 76092
Phone (817) 328-3000

521 W Southlake Blvd
Ste 150
Southlake, TX 76092
Phone (817) 328-3000

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1063893378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 VILLA DI LAGO",
            "address_2": "UNIT 3",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750546622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MIRON DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927852",
            "telephone_number": "817-328-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADOUSKY",
        "first_name": "ANDREW",
        "credential": "MS, FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP127302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.