NPIMap

Organization Active NPI

Peach State Medical Practice, PC

Doing business as Kindbody of TX Medical Practice

  • Ambulatory Fertility Facility
  • Austin, TX
National Provider Identifier
1083295638
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Fertility FacilityTaxonomy code 261QA0006X
Legal business name
PEACH STATE MEDICAL PRACTICE, PC
Doing business as
Kindbody of TX Medical Practice
Practice address
100 Colorado St
Austin, TX 78701-4147
Phone
(855) 563-2639
NPI assigned
Apr 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Fahimeh Sasan, DO
Title
Founding OBGYN
Phone
(855) 563-2639

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Fertility Facility 261QA0006X Primary
Non-Surgical Family Planning Clinic/Center 261QF0050X

Addresses

Primary practice location

100 Colorado St
Austin, TX 78701-4147

Mailing address

333 S Desplaines St Ste 201
Chicago, IL 60661-5514
Phone (855) 563-2639

Other practice location 1

1111 Uptown Park Blvd Ste 2
Houston, TX 77056-3224
Phone (281) 719-9355

Other practice location 2

8041 Walnut Hill Ln Ste 870
Dallas, TX 75231-0954
Phone (214) 295-7712

Other names 1

  • Kindbody of TX Medical Practice Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peach State Medical Practice PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2203 S Promenade Blvd
Ste 5185
Rogers, AR 72758
Phone (479) 480-7200

8845 Lyra Dr
Columbus, OH 43240
Phone (380) 222-2731

Practitioners & affiliated clinicians

Practitioners 10

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": "1618444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1083295638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S DESPLAINES ST STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606615514",
            "telephone_number": "855-563-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COLORADO ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787014147",
            "telephone_number": "855-563-2639"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Uptown Park Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770563224",
            "country_code": "US",
            "telephone_number": "281-719-9355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8041 Walnut Hill Ln Ste 870",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752310954",
            "country_code": "US",
            "telephone_number": "214-295-7712",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEACH STATE MEDICAL PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-15",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "SASAN",
        "authorized_official_first_name": "FAHIMEH",
        "authorized_official_title_or_position": "FOUNDING OBGYN",
        "authorized_official_telephone_number": "855-563-2639",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QA0006X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Fertility Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindbody of TX Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kindbody of TX Medical Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.