Souksavanh Lisa Phanthavong, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA07876 Issued in TX

Practice address

4001 Long Prairie Rd Ste 125
Flower Mound, TX 75028-1532

Phone

(972) 539-3030

Fax

(972) 539-3037

NPI assigned

Jul 13, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Souksavanh Lisa Bush Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Topcare Medical Group IncGroup PAC ID 8426239153, 71 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: souksavanh.phanthavong@171276173049860.direct.elationemr.com

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.

• Topcare Medical Group Inc

  dba Clinicas Mi Doctor

  • Specialist
  • Dallas, TX
  • NPI 1730337163
  Medicare reassignment Care Compare group
• Topcare Medical PA

  dba Clinicas Mi Doctor

  • Specialist
  • Irving, TX
  • NPI 1043231400
  NPD (past)

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1619222874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 LONG PRAIRIE RD STE 125",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281532",
            "telephone_number": "972-539-3030",
            "fax_number": "972-539-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 LONG PRAIRIE RD STE 125",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281532",
            "telephone_number": "972-539-3030",
            "fax_number": "972-539-3037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "941 E Park Row Dr",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760104508",
            "country_code": "US",
            "telephone_number": "817-522-0221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHANTHAVONG",
        "first_name": "SOUKSAVANH",
        "middle_name": "LISA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOUKSAVANH",
            "last_name": "BUSH",
            "middle_name": "LISA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.