Fairway Family Medicine-Primary Care, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

L3196 Issued in TX

Legal business name

FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC

Practice address

4100 Fairway Dr
320
Carrollton, TX 75010-6525

Phone

(972) 236-7608

NPI assigned

Sep 4, 2012

Last updated

Sep 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Hong Xiao, M.D.NPI 1669434601

Title

Medical Director

Phone

(469) 878-9480

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Hong Xiao, MD

  • Adult Medicine Physician
  • Carrollton, TX
  • NPI 1669434601
  Medicare reassignment Care Compare group Authorized official
• Thuc-Nguyen Vu Tran, DO

  • Adult Medicine Physician
  • Carrollton, TX
  • NPI 1114995305
  Medicare reassignment Care Compare group
• Jeffrey Jessada Lertdilok, FNP-C

  • Family Nurse Practitioner
  • Carrollton, TX
  • NPI 1720621071
  NPD
• Sky Lee, FNP

  • Family Nurse Practitioner
  • Plano, TX
  • NPI 1033982772
  NPD (past)

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

{
    "created_epoch": "1346716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346716800000",
    "number": "1508115718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 FAIRWAY DR",
            "address_2": "320",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106525",
            "telephone_number": "972-236-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 FAIRWAY DR",
            "address_2": "320",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106525",
            "telephone_number": "972-236-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-04",
        "last_updated": "2012-09-04",
        "status": "A",
        "authorized_official_last_name": "XIAO",
        "authorized_official_first_name": "HONG",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "469-878-9480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "L3196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Surgery Center of North Dallas
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• Joanne Madeline Fabrick, MA, LPC
• Mitchell Franklin Fagelman, M.D.
• Fair Acres Emergency Physicians, PLLC
• Fairway Pediatrics, PLLC
• Shireen Faisal, DNAP
• Shantell Marie Faithful
• Vanessa Fajardo, LPC
• Huma Fakhr

• Primary Care Clinic/Center in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.