Individual provider Active NPI

Gerald G George, D.O.

  • Family Medicine Physician
  • Grand Prairie, TX
National Provider Identifier
1356316772
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K0473 Issued in TX
Practice address
5224 S State Highway 360 Ste 230
Grand Prairie, TX 75052-0964
Phone
(972) 522-0691
Fax
(972) 522-1053
NPI assigned
Feb 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K0473 TX Primary

Addresses

Primary practice location

5224 S State Highway 360 Ste 230
Grand Prairie, TX 75052-0964

Mailing address

5224 S State Highway 360 Ste 230
Grand Prairie, TX 75052-0964
Phone (972) 522-0691

Other identifiers 2

IdentifierTypeStateIssuer
146001602MedicaidTX
8A7049OtherTXBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070208000077 TX Practitioner - Family Practice 5597667030 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
K0473TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medhealth CurrentSince Oct 31, 2000 Accepting new patients
Medhealth Family Medicine CurrentSince Jan 2, 2007 Accepting new patients

Locations

3400 W Wheatland Rd
Ste 360
Dallas, TX 75237

221 W Colorado Blvd
Ste 740
Dallas, TX 75208
Phone (214) 941-0198

5224 S State Highway 360
Grand Prairie, TX 75052
Phone (972) 522-0691

5224 S State Highway 360
Ste 230
Grand Prairie, TX 75052
Phone (972) 522-0691

4116 S Carrier Pkwy
Ste 250
Grand Prairie, TX 75052
Phone (972) 263-5272

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1356316772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5224 S STATE HIGHWAY 360 STE 230",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750520964",
            "telephone_number": "972-522-0691",
            "fax_number": "972-522-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5224 S STATE HIGHWAY 360 STE 230",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750520964",
            "telephone_number": "972-522-0691",
            "fax_number": "972-522-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "GERALD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K0473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146001602",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "8A7049",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.