Organization Active NPI

David W Carlson MD PA

  • Primary Care Clinic/Center
  • Garland, TX
National Provider Identifier
1356768006
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
HO233 Issued in TX
Legal business name
DAVID W CARLSON MD PA
Practice address
4402 Broadway Blvd
Suite 1
Garland, TX 75043-8263
Phone
(972) 240-1789
NPI assigned
Mar 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Authorized official

Name
Sylvia Carlson
Title
Business Manager
Phone
(972) 240-1789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X HO233 TX Primary

Addresses

Primary practice location

4402 Broadway Blvd
Suite 1
Garland, TX 75043-8263

Mailing address

4402 Broadway Blvd
Suite 1
Garland, TX 75043-8263
Phone (972) 240-1789

Other identifiers 2

IdentifierTypeStateIssuer
1700961406OtherTXNPI
C14201OtherTXUPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140428000482 TX Part B Supplier - Clinic/Group Practice 9830322809 Receives reassigned benefits from 1 practitioner
Practice locations: Garland, TX

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
45D0692129David W Carlson MD, PA4402 Broadway Suite 1, Garland, TX 75043Provider-performed microscopyMar 30, 2027

National Provider Directory

National Provider Directory

Locations

4402 Broadway Blvd
Ste 1
Garland, TX 75043
Phone (972) 240-1789

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1356768006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 BROADWAY BLVD",
            "address_2": "SUITE 1",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750438263",
            "telephone_number": "972-240-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 BROADWAY BLVD",
            "address_2": "SUITE 1",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750438263",
            "telephone_number": "972-240-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID W CARLSON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "972-240-1789"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "HO233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1700961406",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C14201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.