Individual provider Active NPI

Henry T Horrilleno, MD

  • Vascular Surgery Physician
  • Plano, TX
National Provider Identifier
1558310219
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
G1042 Issued in TX
Practice address
4700 Dexter Dr Ste 400
Plano, TX 75093-5299
Phone
(469) 209-8100
Fax
(469) 209-8101
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 25632 OK
Vascular Surgery Physician 2086S0129X G1042 TX Primary

Addresses

Primary practice location

4700 Dexter Dr Ste 400
Plano, TX 75093-5299

Mailing address

4700 Dexter Dr Ste 400
Plano, TX 75093-5299
Phone (469) 209-8100

Other identifiers 1

IdentifierTypeStateIssuer
200115770AMedicaidOK

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200910001362 TX Practitioner - General SurgeryPractitioner - Internal Medicine 0941244073 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G1042TXMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas Regenerative and Neuropathy Center PLLC CurrentSince Jul 18, 2019 Accepting new patients
Southwest Vascular and Surgical Group Surgery Past Accepting new patients
Vein Center for Excellence of Dallas Vascular Surgery Past Accepting new patients

Locations

4700 Dexter Dr
Ste 400
Plano, TX 75093
Phone (469) 209-8100

Organizations & group practices 4

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1558310219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 DEXTER DR STE 400",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935299",
            "telephone_number": "469-209-8100",
            "fax_number": "469-209-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 DEXTER DR STE 400",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935299",
            "telephone_number": "469-209-8100",
            "fax_number": "469-209-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORRILLENO",
        "first_name": "HENRY",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OK",
            "license": "25632",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "G1042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200115770A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.