Immanuel Family Clinic PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

IMMANUEL FAMILY CLINIC PLLC

Practice address

2760 E Trinity Mills Rd Ste 115
Carrollton, TX 75006-2194

Phone

(469) 900-8211

NPI assigned

Jan 15, 2020

Last updated

Feb 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sutha M Fernando, FNPNPI 1093255580

Title

Owner

Phone

(214) 625-2808

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Sutha M Fernando

  • Family Nurse Practitioner
  • Carrollton, TX
  • NPI 1093255580
  Medicare reassignment Care Compare group NPD Authorized official
• Jaya Matharage, MSN

  • Family Nurse Practitioner
  • Flower Mound, TX
  • NPI 1205558251
  Medicare reassignment Care Compare group NPD
• Justin John Wilson, FNP

  • Family Nurse Practitioner
  • Princeton, TX
  • NPI 1659186302
  Medicare reassignment Care Compare group NPD
• Joel William Houghton, FNP-BC

  • Family Nurse Practitioner
  • Victoria, TX
  • NPI 1225691736
  Medicare reassignment NPD

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1265072490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 E TRINITY MILLS RD STE 115",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750062194",
            "telephone_number": "469-900-8211",
            "fax_number": "214-617-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 E TRINITY MILLS RD STE 115",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750062194",
            "telephone_number": "469-900-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMANUEL FAMILY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "FERNANDO",
        "authorized_official_first_name": "SUTHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-625-2808",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HIPPA",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2760 E Trinity Mills Rd Ste 115",
            "city": "Carrollton",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750062194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ies Carrollton PLLC
• Deborah C Igidi, MANAGER
• IHS Acquisition No 132 Inc (Heritage Gardens Healthcare Center)
• Asifa Ijaz, M.D
• Gloria Oluchi Ikonne
• Impel Management Services, LLC (Great Outcomes)
• Imperial Diagnostics LLC
• Implants & Gumcare PA
• Imvaria Labs LLC (IMVARIA Labs)
• Infinite Health Care Service LLC (divine roses hospice)

• Family Nurse Practitioner in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.