Organization Active NPI

Surgical Group of North Texas, PLLC

  • Surgery Physician
  • Grapevine, TX
National Provider Identifier
1124085956
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICAL GROUP OF NORTH TEXAS, PLLC
Practice address
1056 Texan TRL
Grapevine, TX 76051-3703
Phone
(817) 251-0070
Fax
(817) 527-6610
NPI assigned
Apr 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Authorized official

Name
Sina Matin, M.D.
Title
Partner
Phone
(817) 251-0070

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1056 Texan TRL
Grapevine, TX 76051-3703

Mailing address

PO Box 204803
Dallas, TX 75320-4803
Phone (817) 251-0070

Other practice location 1

9509 N Beach St Ste 102
Fort Worth, TX 76244-6399
Phone (817) 251-0070

Other practice location 2

12461 Timberland Blvd Ste 301
Fort Worth, TX 76244-5212
Phone (817) 251-0070

National Provider Directory

National Provider Directory

Locations

12461 Timberland Blvd
Ste 301
Fort Worth, TX 76244
Phone (817) 251-0070

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1124085956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 204803",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753204803",
            "telephone_number": "817-251-0070",
            "fax_number": "817-527-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 TEXAN TRL",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513703",
            "telephone_number": "817-251-0070",
            "fax_number": "817-527-6610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9509 N Beach St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "762446399",
            "country_code": "US",
            "telephone_number": "817-251-0070",
            "fax_number": "817-527-6610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12461 Timberland Blvd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "762445212",
            "country_code": "US",
            "telephone_number": "817-251-0070",
            "fax_number": "817-527-6610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGICAL GROUP OF NORTH TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "MATIN",
        "authorized_official_first_name": "SINA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "817-251-0070",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; 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.