Individual provider Active NPI

Nancy Georgekutty, M.D.

  • Family Medicine Physician
  • Mansfield, TX
National Provider Identifier
1578735106
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N0782 Issued in TX
Practice address
1601 E Debbie LN
Suite 2109
Mansfield, TX 76063-3674
Phone
(817) 473-9125
Fax
(817) 473-9126
NPI assigned
Mar 24, 2008
Last updated
Jun 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N0782 TX Primary

Addresses

Primary practice location

1601 E Debbie LN
Suite 2109
Mansfield, TX 76063-3674

Mailing address

1601 E Debbie LN
Suite 2109
Mansfield, TX 76063-3674
Phone (817) 473-9125

Other identifiers 1

IdentifierTypeStateIssuer
196505502MedicaidTX

Other names 1

  • Nancy Alexander Other name

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
I20081010000624 TX Practitioner - Family Practice 9739257247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MedhealthGroup PAC ID 9931001567, 435 clinicians

Practice addresses (Care Compare)

1601 E Debbie LN
Suite 2109
Mansfield, TX 76063-4130
Phone (817) 473-9125

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
N0782TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medhealth CurrentSince Sep 21, 2009 Accepting new patients
Medhealth Family Medicine CurrentSince Sep 21, 2009 Accepting new patients

Locations

5224 S State Highway 360
Grand Prairie, TX 75052
Phone (972) 522-0691

1601 E Debbie Ln
Ste 2109
Mansfield, TX 76063
Phone (817) 453-8620

Interoperability endpoints

  • Direct secure messaging: ngeorgekutty14364@dm.mhd.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434067200000",
    "number": "1578735106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 E DEBBIE LN",
            "address_2": "SUITE 2109",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633674",
            "telephone_number": "817-473-9125",
            "fax_number": "817-473-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E DEBBIE LN",
            "address_2": "SUITE 2109",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633674",
            "telephone_number": "817-473-9125",
            "fax_number": "817-473-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEORGEKUTTY",
        "first_name": "NANCY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-24",
        "last_updated": "2015-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196505502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "ALEXANDER",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.