Active NPI
Gowtham Ganesan
- Family Medicine Physician
- Dallas, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1407434418
- Practice address
- 3500 Gaston Ave
Dallas, TX 75246-2017 - Phone
- (214) 820-2361
- NPI assigned
- Mar 31, 2021
- Last updated
- Jul 1, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1407434418 | TX | Primary |
Addresses
Primary practice location
3500 Gaston Ave
Dallas, TX 75246-2017
Mailing address
925 E Southlake Blvd
Southlake, TX 76092-1476
Phone (817) 912-8800
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
925 E Southlake Boulevard
100 Baylor Scott and White Urgent Care Southl
Southlake, TX 76092-1477
Phone (817) 912-8560
Hospital & facility affiliations
- Healing Hands Healthcare LLC
- Accentcare Home Health of Fort Worth
- Encompass Home Health of DFW
- Baylor Scott & White Medical Center Grapevine
- Baylor Scott & White Institute for Rehabilitation
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1407434418 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthtexas Provider Network | Current | Accepting new patients | |
| Healthtexas Provider Network | Family Medicine | Current | Accepting new patients |
| Healthtexas Provider Network | Family Medicine | Current | Accepting new patients |
| Healthtexas Provider Network | Family Medicine | Past | Accepting new patients |
Locations
5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920
301 N Washington Ave
Fl 5
Dallas, TX 75246
Phone (469) 800-8742
3500 Gaston Ave
Dallas, TX 75246
4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665
925 E Southlake Blvd
Ste 100
Southlake, TX 76092
Phone 2143582300 ext. 6225
Interoperability endpoints
- gganesan825068@direct.sw.org
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.
-
- Family Medicine Physician
- Dallas, TX
- NPI 1760488936
-
dba Symmetry Anesthesia
- Anesthesiology Physician
- Lakeway, TX
- NPI 1104714583
-
- Family Medicine Physician
- Colleyville, TX
- NPI 1235135906
-
- Family Medicine Physician
- Plano, TX
- NPI 1003811639
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Baylor Scott & White Medical Center - Grapevine
- General Acute Care Hospital
- Grapevine, TX
- NPI 1073511762
-
dba Baylor Institute for Rehabilitation
- Rehabilitation Hospital
- Dallas, TX
- NPI 1538465901
Inpatient rehabilitation facility
-
- Home Health Agency
- Wichita Falls, TX
- NPI 1457722449
-
dba AccentCare Home Health of Fort Worth
- Home Health Agency
- Fort Worth, TX
- NPI 1023548930
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1407434418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "925 E SOUTHLAKE BLVD",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760921476",
"telephone_number": "817-912-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 GASTON AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752462017",
"telephone_number": "214-820-2361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANESAN",
"first_name": "GOWTHAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-31",
"last_updated": "2024-07-01",
"certification_date": "2024-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "1407434418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.