Chongsuh Bae, DNP
Individual provider Active NPI Family Nurse Practitioner · Benbrook, TX
NPI 1487300398 · NPPES record last updated Mar 1, 2022
Key facts
- NPI
- 1487300398
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1044451 (TX)
- Practice address
- 1160 Sopwith CT
Benbrook, TX 76126-4284 - Phone
- (817) 353-0132
- NPI assigned
- Mar 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240531001471 | TX | Practitioner - Nurse Practitioner | 8628410966 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vpa of Texas PLLC | Current |
Accepting new patients | |
| Vpa of Texas PLLC | Current | Accepting new patients | |
| Vpa of Texas PLLC | Current |
Accepting new patients | |
| Signify Health Medical Associates, PLLC | Current |
Accepting new patients |
Locations
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
4545 Fuller Dr
Ste 325
Irving, TX 75038
Phone (972) 870-5511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1044451 | TX | Yes |
Addresses
Primary practice location
1160 Sopwith CT
Benbrook, TX 76126-4284
Mailing address
1160 Sopwith CT
Benbrook, TX 76126-4284
Phone (817) 353-0132
Other providers in Benbrook, TX
- Jessica Arrington
- Debra Atkisson
- Renee Aviles
- B.E.S.T. of Benbrook, LLC
- Madison Lane Backman
- Jasselle Bagang
- Ian Bailey
- Katherine Baker
- Ballard Family Dentistry in Benbrook
- David Theodore Bancroft
All providers in Benbrook, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.