Active NPI
West Wharton County Hospital District
Doing business as Fair Park Health & Rehabilitation Center
- Skilled Nursing Facility
- Dallas, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- WEST WHARTON COUNTY HOSPITAL DISTRICT
- Doing business as
- Fair Park Health & Rehabilitation Center
- Practice address
- 2815 Martin Luther King Jr Blvd
Dallas, TX 75215-2320 - Phone
- (214) 421-2159
- NPI assigned
- Oct 16, 2023
- Last updated
- Oct 16, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David H Mak
- Title
- Chief Financial Officer
- Phone
- (713) 569-7370
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
2815 Martin Luther King Jr Blvd
Dallas, TX 75215-2320
Mailing address
4150 International PLZ Ste 600
Fort Worth, TX 76109-4831
Phone (817) 348-8959
Other names 1
- Fair Park Health & Rehabilitation Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240509000460 | TX | Part A Provider - Skilled Nursing Facility | 7517952047 | Practice locations: Dallas, TX |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1093597064. Details of each certification follow.
Skilled nursing facility certification: CCN 675417
- Legal name
- WEST WHARTON COUNTY HOSPITAL DISTRICT
- Doing business as
- FAIR PARK HEALTH & REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Nov 16, 1994
- Last certification
- May 14, 2025
- Beds
- 114
- Ownership / control type
- Corporation
- Multi-facility organization
- Creative Solutions in Healthcare
- Most recent change of ownership
- Dec 1, 2023
- Organization structure
- Other
- Enrollment address
- 2815 Martin Luther King Jr Blvd
Dallas, TX 75215-2320 - Nursing home name
- FAIR PARK HEALTH & REHABILITATION CENTER
- Affiliated entity
- CREATIVE SOLUTIONS IN HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fair Park Health & Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 16, 1994
- Medicare certification status
- Active
- Certified beds
- 114
- Chain
- Creative Solutions in Healthcare
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
National Provider Directory
National Provider Directory- Tax ID family
- West Wharton County Hospital District
Organizations with this tax ID in the same state 20
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Clinic/Center
- Palacios, TX
- NPI 1184707473
-
dba Normandy Terrace Nursing & Rehabilitation Center
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1003527748
-
dba Estates Healthcare and Rehabilitation Center
- Skilled Nursing Facility
- Fort Worth, TX
- NPI 1013628759
-
dba Lakeside Nursing and Rehabilitation Center
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1023576865
-
dba Avir at Abilene
- Skilled Nursing Facility
- Abilene, TX
- NPI 1023641024
-
dba Twin Pines Nursing and Rehabilitation
- Skilled Nursing Facility
- Victoria, TX
- NPI 1023743028
-
dba The Rio at Mission Trials
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1073082590
-
dba Mullican Care Center
- Skilled Nursing Facility
- Savoy, TX
- NPI 1083496061
-
dba Avir at Heritage
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1093273732
-
dba El Paso Health & Rehabilitation Center
- Skilled Nursing Facility
- El Paso, TX
- NPI 1124352901
-
dba Whitesboro Health & Rehabilitation Center
- Skilled Nursing Facility
- Whitesboro, TX
- NPI 1144002122
-
dba Central Texas Nursing & Rehabilitation
- Skilled Nursing Facility
- Ballinger, TX
- NPI 1154056158
Ownership & related parties
All disclosed owners & managing parties 7
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| David Mak | Corporate Officer | May 17, 2021 | 100% |
| Malisa a Blake | Other | Dec 1, 2023 | 50% |
| Gary R Blake | Operational/Managerial Control | Dec 1, 2023 | |
| Other | Dec 1, 2023 | 50% | |
| Dallas III Enterprises LLC | Operational/Managerial Control | Dec 1, 2023 | 100% |
| Linda F Huggins | Corporate Director | Dec 1, 2023 | |
| Honor X Enterprises, LLC | Other | Dec 1, 2023 | 100% |
| West Wharton County Hospital District | 5% Or Greater Direct Ownership Interest | Dec 1, 2023 | 100% |
All facility ownership & control disclosures 91
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakeside Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2022 |
| Mystic Park Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2022 |
| West Oaks Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Avir at River Ridge | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Avir at Heritage | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Avir at Portland | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2019 |
| Avir at El Paso | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2020 |
| Avir at Abilene | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2020 |
| Rollingbrook Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2021 |
| Brush Country Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2021 |
| Gulf Shores Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2021 |
| Midlothian Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2024 |
| Prairie Meadows Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2021 |
| West Houston Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2021 |
| Lakeview Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2021 |
| Granbury Care Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Amarillo Center for Skilled Care | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Sterling Hills Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| De Leon Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Sun Valley Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Lone Star Ranch Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Shiner Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Renaissance Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Twin Pines North Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Greenhill Villas | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| The Arbors Healthcare and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Twilight Home | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Oasis Nursing & Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Willow Park Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Southern Specialty Rehab & Nursing | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Marine Creek Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Huebner Creek Health & Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| The Hills Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Mineral Wells Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| The Rio at Mission Trails | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| The Premier SNF of Alice | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Franklin Heights Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Silver Tree Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Sienna Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2022 |
| Buena Vida Nursing & Rehab San Antonio | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Apr 1, 2022 Sep 1, 2022 |
| Cypress Creek Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2022 |
| Skilled Care of Mexia | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2022 |
| Care Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2020 Sep 1, 2020 |
| Concho Health and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2022 Sep 1, 2022 |
| Devine Health and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2022 Sep 1, 2021 |
| Bertram Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Amistad Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| San Saba Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Rock Creek Health and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| The Atrium of Bellmead | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Ganado Nursing and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2022 Sep 1, 2022 |
| Shady Oak Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| La Hacienda de Paz Rehabilitation and Care Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2022 Sep 1, 2022 |
| Oak Ridge Manor | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2020 |
| Sunflower Park Health Care | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Songbird Lodge | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Matagorda Nursing & Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Villa Toscana at Cypress Woods | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Central Texas Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Sep 1, 2022 Sep 1, 2021 |
| Avir at Azalea Heights | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 15, 2022 |
| Five Points at Lake Highlands Nursing and Rehab | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| Treemont Healthcare and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| Normandy Terrace Nursing & Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| Brentwood Terrace Healthcare and Rehabillitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2023 |
| El Paso Health and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Estates Healthcare and Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Feb 1, 2023 Sep 1, 2023 |
| Five Points Nursing and Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2023 |
| The Heights on Valley Ranch | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2023 |
| The Enclave | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2023 |
| Park Bend Rehabilitation and Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2023 |
| Brownwood Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Jul 1, 2023 Jul 1, 2023 |
| Castro County Nursing & Rehabilitation | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Sep 1, 2023 Sep 1, 2023 |
| Buena Vida Nursing & Rehab Odessa | Skilled nursing facility | Direct Ownership Interest (100%) | Aug 1, 2019 |
| Avir at Madisonville | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 14, 2023 |
| Avir at Lindale | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Beltline Healthcare Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Avir at Pilot Point | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| River Bend Healthcare | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2024 |
| Avir at Patriot | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Whitesboro Health & Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Direct Ownership Interest (100%) |
Dec 1, 2023 Sep 1, 2024 |
| Mustang Park Therapy and Living Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 1, 2024 |
| University Rehabilitation Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Grace Pointe Wellness Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Avir at Rose Trail | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2024 |
| Avir at Petal Hill | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2020 |
| Southern Oaks Therapy and Living Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2026 |
| Vintage Health Care Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest | Dec 1, 2023 |
| Mallard Creek Therapy and Living Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2026 |
| Rockwall Nursing Care Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2023 |
| Avir at Tierra Este | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2025 |
| Avir at Kerrville | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 2025 |
Facilities with the same owner 90
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba River Bend Healthcare
- Skilled Nursing Facility
- Seguin, TX
- NPI 1245099423
West Wharton County Hospital District
-
dba Normandy Terrace Nursing & Rehabilitation Center
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1003527748
West Wharton County Hospital District
-
dba Estates Healthcare and Rehabilitation Center
- Skilled Nursing Facility
- Fort Worth, TX
- NPI 1013628759
West Wharton County Hospital District
-
dba Huebner Creek Health & Rehabilitation Center
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1023443579
West Wharton County Hospital District
-
dba Lakeside Nursing and Rehabilitation Center
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1023576865
West Wharton County Hospital District
-
dba Avir at Abilene
- Skilled Nursing Facility
- Abilene, TX
- NPI 1023641024
West Wharton County Hospital District
-
dba The Rio at Mission Trials
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1073082590
West Wharton County Hospital District
-
dba Avir at Heritage
- Skilled Nursing Facility
- San Antonio, TX
- NPI 1093273732
West Wharton County Hospital District
-
dba El Paso Health & Rehabilitation Center
- Skilled Nursing Facility
- El Paso, TX
- NPI 1124352901
West Wharton County Hospital District
-
dba Whitesboro Health & Rehabilitation Center
- Skilled Nursing Facility
- Whitesboro, TX
- NPI 1144002122
West Wharton County Hospital District
-
dba Brush Country Nursing and Rehabilitation
- Skilled Nursing Facility
- Austin, TX
- NPI 1144607334
West Wharton County Hospital District
-
dba Central Texas Nursing & Rehabilitation
- Skilled Nursing Facility
- Ballinger, TX
- NPI 1154056158
West Wharton County Hospital District
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Family Medicine Physician
- Dallas, TX
- NPI 1477571883
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697414400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1697414400000",
"number": "1093597064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4150 INTERNATIONAL PLZ STE 600",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761094831",
"telephone_number": "817-348-8959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2815 MARTIN LUTHER KING JR BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752152320",
"telephone_number": "214-421-2159"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST WHARTON COUNTY HOSPITAL DISTRICT",
"organizational_subpart": "NO",
"enumeration_date": "2023-10-16",
"last_updated": "2023-10-16",
"certification_date": "2023-10-16",
"status": "A",
"authorized_official_last_name": "MAK",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "H",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "713-569-7370"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fair Park Health & Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Dallas, TX
- West Coast University
- West Texas Counseling and Rehabilitation of Dallas, Inc. (WTCR Dallas, Inc.)
- West Texas Pain Associates, P.a.
- West Village Emergency Physicians PLLC
- West Village Eye Pieces PC
- West Wharton County Hospital District (Avir at White Rock)
- West Wharton County Hospital District (Southern Oaks Therapy and Living Center)
- West Wharton County Hospital District (Treemont Healthcare and Rehabilitation Center)
- Albert West V, MA, LPC-S, CET
- Amanda Rose West, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.