Individual provider Active NPI

Sasiwan W Kamthong, F.N.P.

  • Family Nurse Practitioner
  • Garland, TX
National Provider Identifier
1457308967
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP111202 Issued in TX
Practice address
2636 W Walnut St
Garland, TX 75042-6485
Phone
(972) 487-5800
Fax
(972) 487-9680
NPI assigned
May 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP111202 TX
Family Nurse Practitioner 363LF0000X AP111202 TX Primary

Addresses

Primary practice location

2636 W Walnut St
Garland, TX 75042-6485

Mailing address

122 W John Carpenter Fwy Ste 420
Irving, TX 75039-2014
Phone (972) 957-3000

Other identifiers 1

IdentifierTypeStateIssuer
147897601MedicaidTX

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
I20120305000674 TX Practitioner - Nurse Practitioner 6608035068 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Topcare Medical Group IncGroup PAC ID 8426239153, 71 clinicians

Practice addresses (Care Compare)

1111 S Irving Heights Dr
Clinicas Mi Doctor
Irving, TX 75060-6237
Phone (972) 579-7979

229 NE 28TH St
Clinicas Mi Doctor
Fort Worth, TX 76164-7205
Phone (817) 566-0483

410 E Pioneer Pkwy
300 Clinicas Mi Doctor
Grand Prairie, TX 75051-4984
Phone (469) 733-1890

941 E Park Row Dr
Clinicas Mi Doctor
Arlington, TX 76010-4508
Phone (817) 522-0221

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP111202TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
D&J Grace Team LLC Nurse Practitioner CurrentSince Apr 1, 2021 Accepting new patients

Locations

921 FM 1187 E
Ste A
Crowley, TX 76036
Phone (817) 297-2000

6251 Oakmont Blvd
Ft Worth, TX 76132
Phone (682) 250-5700

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": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1457308967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 W JOHN CARPENTER FWY STE 420",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750392014",
            "telephone_number": "972-957-3000",
            "fax_number": "972-957-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2636 W WALNUT ST",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750426485",
            "telephone_number": "972-487-5800",
            "fax_number": "972-487-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMTHONG",
        "first_name": "SASIWAN",
        "middle_name": "W",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP111202",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP111202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147897601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

Verify at the official NPI Registry.