US Iom Neuro LLC

Primary specialty

Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X

Legal business name

US IOM NEURO LLC

Practice address

3301 Hamilton Ave Ste 101
Ft Worth, TX 76107-1847

Phone

(817) 529-8488

NPI assigned

May 15, 2019

Last updated

Oct 15, 2024By 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

Gina SullivanNPI 1710506100

Title

Billing Manager

Phone

(903) 259-0550

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Gina M Sullivan, CMA CPC

  • Physician Office Based Coding Specialist
  • Caddo Mills, TX
  • NPI 1710506100
  Authorized official Same address or phone

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1598321580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 CAMP BOWIE BLVD # 114-67",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761073826",
            "telephone_number": "817-529-8488",
            "fax_number": "903-259-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 HAMILTON AVE STE 101",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761071847",
            "telephone_number": "817-529-8488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Boland St Ste 211",
            "address_purpose": "LOCATION",
            "city": "Ft Worth",
            "state": "TX",
            "postal_code": "761071265",
            "country_code": "US",
            "telephone_number": "817-529-8488",
            "fax_number": "903-328-6568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "US IOM NEURO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "903-259-0550"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Electrodiagnostic Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Electrodiagnostic Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.