NPIMap

Organization Active NPI

Exelon Health Management LLC

  • Clinic/Center
  • Dallas, TX
National Provider Identifier
1124995279
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EXELON HEALTH MANAGEMENT LLC
Practice address
9304 Forest LN Ste S145
Dallas, TX 75243-6238
Phone
(708) 505-6789
NPI assigned
Oct 22, 2025
Last updated
Oct 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Authorized official

Name
Shiva Reddy Thotapally
Title
Director
Phone
(708) 505-6789

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

9304 Forest LN Ste S145
Dallas, TX 75243-6238

Mailing address

9304 Forest LN Ste S145
Dallas, TX 75243-6238
Phone (708) 505-6789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260324003451 TX Part B Supplier - Clinic/Group Practice 0143704478 Receives reassigned benefits from 11 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

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": "1761091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1124995279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9304 FOREST LN STE S145",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752436238",
            "telephone_number": "708-505-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9304 FOREST LN STE S145",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752436238",
            "telephone_number": "708-505-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXELON HEALTH MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-22",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "THOTAPALLY",
        "authorized_official_first_name": "SHIVA REDDY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-505-6789"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.