NPIMap

Individual provider Active NPI

Sanjoy Sundaresan, M.D.

  • Neurological Surgery Physician
  • Wichita Falls, TX
National Provider Identifier
1376504894
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
K1083 Issued in TX
Practice address
1511 10TH St
Wichita Falls, TX 76301-4430
Phone
(940) 767-0818
Fax
(940) 763-8096
NPI assigned
Apr 1, 2006
Last updated
Oct 15, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X K1083 TX Primary

Addresses

Primary practice location

1511 10TH St
Wichita Falls, TX 76301-4430

Mailing address

1511 10TH St
Wichita Falls, TX 76301-4430
Phone (940) 767-0818

Other identifiers 1

IdentifierTypeStateIssuer
1336471-04MedicaidTX

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
I20040519001412 TX Practitioner - Pain ManagementPractitioner - Neurosurgery 0345158960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Neurosurgery
Education
Yale University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1511 10TH St
Wichita Falls, TX 76301-4430
Phone (940) 767-0818

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Laminectomy or laminotomy (partial removal of spine bones)1-10

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

State licenses

LicenseStateTypeSpecialty
K1083TXMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Regional Health Care System Inc Current Accepting new patients
Sanjoy Sundaresan MD PA Neurological Surgery CurrentSince Oct 1, 1998 Accepting new patients
Wichita Valley Rehabilitation Hospital PastSince Oct 17, 2002 Accepting new patients
San-Sun 2014 Series LLC PastSince May 14, 2023 Accepting new patients

Locations

1100 W Business 380
Unit F
Decatur, TX 76234
Phone (940) 626-0074

1015 Hillcrest Dr
Vernon, TX 76384
Phone (940) 552-5495

804 Santa Fe Dr
Ste 100A
Weatherford, TX 76086
Phone (866) 730-2644

1511 10th St
Wichita Falls, TX 76301
Phone (940) 767-0818

Interoperability endpoints

  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
  • Direct secure messaging: sanjoysundaresan@texomaspine.ssdirect.aprima.com
  • Direct secure messaging: ssundaresan14802@unitedregional.medalliesdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Horizon Medical Center of McKinney, LLCMcKinney, TX, CCN 743031 Hospital Other Feb 19, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413331200000",
    "number": "1376504894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 10TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014430",
            "telephone_number": "940-767-0818",
            "fax_number": "940-763-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 10TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014430",
            "telephone_number": "940-767-0818",
            "fax_number": "940-763-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDARESAN",
        "first_name": "SANJOY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-01",
        "last_updated": "2014-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "K1083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336471-04",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.