NPIMap

Organization Active NPI

Medistat Group Associates, Inc.

  • Adult Medicine Physician
  • Desoto, TX
National Provider Identifier
1376565341
Registry record updated Oct 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
MEDISTAT GROUP ASSOCIATES, INC.
Practice address
2617 Bolton Boone Dr
Suite B
Desoto, TX 75115-2074
Phone
(972) 709-1781
Fax
(972) 709-1782
NPI assigned
Jul 25, 2006
Last updated
Oct 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2008

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

Authorized official

Name
Mrs. Teri Louise Shipman
Title
Office Manager
Phone
(972) 709-1781

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Pulmonary Function TechnologistGroup: 193200000X MULTI-SPECIALTY GROUP 225B00000X
Pulmonary Rehabilitation Certified Respiratory TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2278P1005X
Health Service Clinic/Center 261QH0100X G6955 TX
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

2617 Bolton Boone Dr
Suite B
Desoto, TX 75115-2074

Mailing address

2617 Bolton Boone Dr
Suite B
Desoto, TX 75115-2074
Phone (972) 709-1781

National Provider Directory

National Provider Directory

Locations

3917 W Camp Wisdom Rd
Ste 108
Dallas, TX 75237
Phone (972) 709-1781

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223164800000",
    "number": "1376565341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2617 BOLTON BOONE DR",
            "address_2": "SUITE B",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152074",
            "telephone_number": "972-709-1781",
            "fax_number": "972-709-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2617 BOLTON BOONE DR",
            "address_2": "SUITE B",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152074",
            "telephone_number": "972-709-1781",
            "fax_number": "972-709-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISTAT GROUP ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2008-10-05",
        "status": "A",
        "authorized_official_last_name": "SHIPMAN",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-709-1781",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225B00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pulmonary Function Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2278P1005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Respiratory Therapist, Certified, Pulmonary Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "TX",
            "license": "G6955",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.