NPIMap

Organization Active NPI

Kingsley Medical Clinic, P.a.

Doing business as ridgewood medical clinic

  • Family Medicine Physician
  • Garland, TX
National Provider Identifier
1497876288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KINGSLEY MEDICAL CLINIC, P.A.
Doing business as
ridgewood medical clinic
Practice address
219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448
Phone
(972) 271-5544
NPI assigned
Apr 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Bruce E. Wardlay, D.ONPI 1881810794
Title
Owner
Phone
(972) 271-5544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448

Mailing address

219 W Kingsley Rd
Suit 336
Garland, TX 75041-3448
Phone (972) 271-5544

Other names 1

  • ridgewood medical clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000109 TX Part B Supplier - Clinic/Group Practice 8426941899 Receives reassigned benefits from 8 practitioners
Practice locations: Garland, TX

National Provider Directory

National Provider Directory

Locations

219 W Kingsley Rd
Ste 336
Garland, TX 75041
Phone (972) 271-5544

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497876288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 W KINGSLEY RD",
            "address_2": "SUIT 336",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750413448",
            "telephone_number": "972-271-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 W KINGSLEY RD",
            "address_2": "SUIT 336",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750413448",
            "telephone_number": "972-271-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSLEY MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WARDLAY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-271-5544",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ridgewood medical clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.