Individual provider Active NPI

Sanober Kassimali, FNP-C

  • Family Nurse Practitioner
  • Garland, TX
National Provider Identifier
1447737564
Registry record updated Jan 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP138046 Issued in TX
Practice address
2241 Peggy LN Ste E
Garland, TX 75042-5709
Phone
(972) 494-1155
NPI assigned
Jul 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP138046 TX Primary

Addresses

Primary practice location

2241 Peggy LN Ste E
Garland, TX 75042-5709

Mailing address

8404 Foothill Dr
Plano, TX 75024-6865
Phone (214) 558-8861

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181024001418 TX Practitioner - Nurse Practitioner 8628385523 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP138046TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chaitanya Tummala MD PA CurrentSince Jul 19, 2021 Accepting new patients
Claire E Brenner MD PA CurrentSince Nov 1, 2018 Accepting new patients

Locations

4461 Coit Rd
Ste 409
Frisco, TX 75035
Phone (214) 396-8877

2241 Peggy Ln
Ste E
Garland, TX 75042
Phone (972) 276-6191

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1532131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547769600000",
    "number": "1447737564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8404 FOOTHILL DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246865",
            "telephone_number": "214-558-8861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 PEGGY LN STE E",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750425709",
            "telephone_number": "972-494-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASSIMALI",
        "first_name": "SANOBER",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-21",
        "last_updated": "2019-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP138046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

Verify at the official NPI Registry.