Mansfield Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MANSFIELD ENDOSCOPY CENTER, LLC

Practice address

647 N Miller Rd
Mansfield, TX 76063-5820

Phone

(817) 893-2381

NPI assigned

Dec 4, 2020

Organization subpart

Yes

Parent organization

GI ALLIANCE SURGERY CENTER, PLLCAs reported in NPPES

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

Authorized official

Name

Kelly Rouvaldt

Title

Director of ASC Operations

Phone

(817) 415-9670

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Mansfield Endoscopy Center LLCCCN 45C0001732

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 1

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

• Texas Digestive Disease Consultants PLLC

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1295428415

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1366047433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 N MILLER RD",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636083",
            "telephone_number": "817-415-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 N MILLER RD",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760635820",
            "telephone_number": "817-893-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANSFIELD ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GI ALLIANCE SURGERY CENTER, PLLC",
        "enumeration_date": "2020-12-04",
        "last_updated": "2022-06-29",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "ROUVALDT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR OF ASC OPERATIONS",
        "authorized_official_telephone_number": "817-415-9670"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMR",
            "affiliation": "Y",
            "endpointDescription": "EMR",
            "affiliationName": "Texas Digestive Disease Consultants, PLLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "647 N Miller Rd",
            "city": "Mansfield",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760635820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mansfield Chiropractic Center LLC
• Mansfield Counseling
• Mansfield Counseling
• Mansfield Dental Associates PA
• Mansfield Dermatology, PLLC
• Mansfield Family Dentistry
• Mansfield Family Therapy Services, LLC
• Mansfield Group Health, LLC
• Mansfield HK Group Health, LLC
• Mansfield Interventional Pain Center, LLC

• Ambulatory Surgical Clinic/Center in Mansfield, TX
• Providers in Mansfield, 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 Jun 29, 2022; 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.