NPIMap

Individual provider Active NPI

Melanie Susan Sulistio, M.D

  • Cardiovascular Disease Physician
  • Dallas, TX
National Provider Identifier
1124037528
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
M2135 Issued in TX
Practice address
5323 Harry Hines Boulevard
Dallas, TX 75390-7201
Phone
(214) 645-7500
Fax
(214) 645-0078
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M2135 TX
Cardiovascular Disease Physician 207RC0000X M2135 TX Primary

Addresses

Primary practice location

5323 Harry Hines Boulevard
Dallas, TX 75390-7201

Mailing address

P.O. Box 845347
Dallas, TX 75284-5347
Phone (214) 645-7500

Other identifiers 1

IdentifierTypeStateIssuer
175964901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050901000564 TX Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4284666058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Texas Medical School at San Antonio, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

1801 Inwood Rd
Dallas, TX 75235-7202
Phone (214) 645-2035

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044
  • Parkland Health & Hospital System Hospital, Dallas, TX, CCN 450015

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Internal Medicine CurrentSince Jul 1, 2009 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 1, 2009 Accepting new patients
Dallas County Hospital District Past Accepting new patients
University of Texas Southwestern Medical Center at Dallas Internal Medicine Past Accepting new patients

Locations

1801 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2035

1801 Inwood Rd
Fl Seventh
Dallas, TX 75235

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

600 S Main St
Ft Worth, TX 76104
Phone (817) 882-2400

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

3030 Waterview Pkwy
Richardson, TX 75080
Phone (972) 669-7070

2001 Inwood Rd
Fl 5
Ut Southwest Medical Center, TX 75390
Phone (214) 645-0538

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: melanie.sulistio@direct.swmed.us

Organizations & group practices 5

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

Hospital & facility affiliations 46

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431907200000",
    "number": "1124037528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752845347",
            "telephone_number": "214-645-7500",
            "fax_number": "214-645-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 HARRY HINES BOULEVARD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753907201",
            "telephone_number": "214-645-7500",
            "fax_number": "214-645-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULISTIO",
        "first_name": "MELANIE",
        "middle_name": "SUSAN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2015-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M2135",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "M2135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175964901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.