NPIMap

Organization Active NPI

Forest Lane Pediatrics

  • Pediatrics Physician
  • Dallas, TX
National Provider Identifier
1225173107
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FOREST LANE PEDIATRICS
Practice address
7777 Forest LN Ste B300
Dallas, TX 75230-2510
Phone
(972) 284-7770
Fax
(972) 284-7780
NPI assigned
Feb 20, 2007
Last updated
Mar 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Authorized official

Name
Shirley Grosvenor
Title
Manager
Phone
(972) 284-7776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

7777 Forest LN Ste B300
Dallas, TX 75230-2510

Mailing address

7777 Forest LN Ste B300
Dallas, TX 75230-2510
Phone (972) 284-7770

Other identifiers 1

IdentifierTypeStateIssuer
0070LMOtherTXBCBS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0988499Forest Lane Pediatrics7777 Forest Lane BLDG B 300, Dallas, TX 75230Certificate of waiverJun 27, 2027
45D2169669Forest Lane Pediatrics7777 Forest LN BLDG B Suite 308, Dallas, TX 75230Certificate of waiverJul 23, 2027

National Provider Directory

National Provider Directory

Locations

7777 Forest Ln
Ste B300
Dallas, TX 75230
Phone (972) 284-7770

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": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1225173107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE B300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302510",
            "telephone_number": "972-284-7770",
            "fax_number": "972-284-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 FOREST LN STE B300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302510",
            "telephone_number": "972-284-7770",
            "fax_number": "972-284-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST LANE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "GROSVENOR",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-284-7776"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0070LM",
            "state": "TX"
        }
    ],
    "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 Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.