Active NPI
Sasiwan W Kamthong, F.N.P.
- Family Nurse Practitioner
- Garland, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP111202
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 147897601 | Medicaid | TX |
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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| AP111202 | TX | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| D&J Grace Team LLC | Nurse Practitioner | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.