NPIMap

Organization Active NPI

Spine Team Texas PA

  • Neurological Surgery Physician
  • Southlake, TX
National Provider Identifier
1629082995
Registry record updated Jul 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
SPINE TEAM TEXAS PA
Practice address
1545 E Southlake Blvd
Suite 100
Southlake, TX 76092
Phone
(817) 442-9300
Fax
(917) 416-0108
NPI assigned
Jul 29, 2006
Last updated
Jul 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2014

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

Authorized official

Name
Mr. Mark C Hood
Title
Ceo
Phone
(817) 442-9300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X NU Primary
Spinal Cord Injury Medicine Physician 2081P0004X NU

Addresses

Primary practice location

1545 E Southlake Blvd
Suite 100
Southlake, TX 76092

Mailing address

1545 E Southlake Blvd
Suite 100
Southlake, TX 76092
Phone (817) 442-9300

Other identifiers 1

IdentifierTypeStateIssuer
00959ZOtherTXMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051230000616 TX Part B Supplier - Clinic/Group Practice 6507888757 Receives reassigned benefits from 132 practitioners
3 other NPIs on this enrollment
Practice locations: Fort Worth, TX; Rockwall, TX; Southlake, TX

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1305 Airport Fwy
Ste 406
Bedford, TX 76021
Phone (817) 318-1414

290 Miron Dr
Southlake, TX 76092
Phone (817) 796-3310

Practitioners & affiliated clinicians

Practitioners 133

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.

View all 133

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1629082995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-442-9300",
            "fax_number": "917-416-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-442-9300",
            "fax_number": "917-416-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE TEAM TEXAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "HOOD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-442-9300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00959Z",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.