NPIMap

Individual provider Active NPI

Balaguru Kolandavelo Sambandam, M.D.

  • Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1265694731
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
P5128 Issued in TX
Practice address
3025 N Tarrant Pkwy Ste 100
Fort Worth, TX 76177-8625
Phone
(817) 717-5268
Fax
(817) 717-8021
NPI assigned
Jun 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X P5128 TX Primary

Addresses

Primary practice location

3025 N Tarrant Pkwy Ste 100
Fort Worth, TX 76177-8625

Mailing address

1540 Keller Pkwy # 108-249
Keller, TX 76248-3686
Phone (817) 717-5268

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
I20130821000966 TX Practitioner - General SurgeryPractitioner - General Practice 8426291501 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: General Practice
Education
University of Texas Southwestern Medical School at Dallas, 2008
Medicare assignment
May accept Medicare assignment
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

1325 Pennsylvania Ave
Suite 690
Fort Worth, TX 76104-2133
Phone (817) 250-7030

1540 Keller Pkwy
Suite 108 249
Keller, TX 76248-4601
Phone (817) 717-5268

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Sep 1, 2023 Accepting new patients
Texas Health Physicians Group CurrentSince Sep 1, 2023 Accepting new patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Harris Methodist Hospital Fort Worth Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

800 5th Ave
Ste 400
Fort Worth, TX 76104
Phone (817) 702-9100

1325 Pennsylvania Ave
Ste 690
Fort Worth, TX 76104
Phone (817) 761-7740

Interoperability endpoints

  • FHIR API: https://epproxy.texashealth.org/FHIR/api/FHIR/DSTU2/
  • Direct secure messaging: bsambandam361537@direct.texashealth.org

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547683200000",
    "number": "1265694731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 KELLER PKWY # 108-249",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483686",
            "telephone_number": "817-717-5268",
            "fax_number": "817-717-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3025 N TARRANT PKWY STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761778625",
            "telephone_number": "817-717-5268",
            "fax_number": "817-717-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMBANDAM",
        "first_name": "BALAGURU",
        "middle_name": "KOLANDAVELO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2019-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "P5128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.