Grapevine Surgicare Partners LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

007819 Issued in TX

Legal business name

GRAPEVINE SURGICARE PARTNERS LTD

Doing business as

Baylor Scott & White Surgicare - Southlake

Practice address

905 E Southlake Blvd
Ste 200
Southlake, TX 76092-8602

Phone

(817) 410-4300

Fax

(817) 410-4303

NPI assigned

Mar 1, 2006

Last updated

Oct 7, 2024By 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

Donita Fleming

Title

Authorized Official

Phone

(202) 815-3665

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Baylor Scott & White Surgicare - Southlake Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Baylor Scott White Surgicare GrapevineCCN 45C0001301

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Locations

Practitioners 1

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.

• Robert S. Pollard, M.D.

  • Surgery Physician
  • Grapevine, TX
  • NPI 1235184433
  NPD (past)

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1295702942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E SOUTHLAKE BLVE",
            "address_2": "STE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928602",
            "telephone_number": "817-410-4300",
            "fax_number": "817-410-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E SOUTHLAKE BLVD",
            "address_2": "STE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928602",
            "telephone_number": "817-410-4300",
            "fax_number": "817-410-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAPEVINE SURGICARE PARTNERS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "DONITA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "202-815-3665"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "007819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490005386",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173382601",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Baylor Scott & White Surgicare - Southlake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baylor Scott & White Surgicare - Southlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Andrew Green, DPT

• Ambulatory Surgical Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; 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.