Individual provider Active NPI

Niyomi De Silva, M.D.

  • Family Medicine Physician
  • Grand Prairie, TX
National Provider Identifier
1447481213
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
T3609 Issued in TX
Practice address
4927 Lake Ridge Pkwy Ste 100
Grand Prairie, TX 75052-3060
Phone
(469) 506-1671
NPI assigned
Jul 28, 2009
Last updated
Mar 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125056535 IL
Family Medicine Physician 207Q00000X 0101253694 VA
Family Medicine Physician 207Q00000X 47283 TX
Family Medicine Physician 207Q00000X ME122692 FL
Family Medicine Physician 207Q00000X T3609 TX Primary

Addresses

Primary practice location

4927 Lake Ridge Pkwy Ste 100
Grand Prairie, TX 75052-3060

Mailing address

4401 Coit Rd Ste 409
Frisco, TX 75035-0519
Phone (469) 800-4130

Other practice location 1

1201 1st St S Ste 100A
Winter Haven, FL 33880-3904
Phone (863) 280-6080

Other identifiers 1

IdentifierTypeStateIssuer
014452700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150512000381 FL Practitioner - Family Practice 0749421881 Reassigns benefits to 1 organization
I20210405002376 TX Practitioner - Family Practice 0749421881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

4401 Coit Rd
Suite 409
Frisco, TX 75035-0519
Phone (469) 800-4130

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125056535ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network Family Medicine CurrentSince Feb 27, 2023 Accepting new patients
Healthtexas Provider Network CurrentSince Feb 27, 2023 Accepting new patients
Hospital Physician Services of Florida PA Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients

Locations

8383 N Davis Hwy
Pensacola, FL 32514
Phone (850) 494-3212

200 Avenue F NE
Winter Haven, FL 33881
Phone (863) 292-4652

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

7777 Forest Ln
Ste C300
Dallas, TX 75230
Phone (972) 566-6000

900 Jerome St
Ste 204
Fort Worth, TX 76104
Phone (817) 885-7827

4401 Coit Rd
Ste 409
Frisco, TX 75035
Phone (469) 800-4130

4927 Lake Ridge Pkwy
Ste 100
Grand Prairie, TX 75052
Phone (913) 669-3321

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: ndesilva1143371@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.

Hospital & facility affiliations 2

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": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1447481213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 COIT RD STE 409",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750350519",
            "telephone_number": "469-800-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523060",
            "telephone_number": "469-506-1671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 1st St S Ste 100A",
            "address_purpose": "LOCATION",
            "city": "Winter Haven",
            "state": "FL",
            "postal_code": "338803904",
            "country_code": "US",
            "telephone_number": "863-280-6080",
            "fax_number": "863-229-7587",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE SILVA",
        "first_name": "NIYOMI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-28",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125056535",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101253694",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "47283",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME122692",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T3609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014452700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.