Dallas Fort Worth Ivf LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D1095599 Issued in TX

Legal business name

DALLAS FORT WORTH IVF LLC

Practice address

5477 Glen Lakes Dr
Suite 201
Dallas, TX 75231-0946

Phone

(214) 363-5965

Fax

(214) 363-0639

NPI assigned

Aug 17, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Samuel J Chantilis, M.D.NPI 1386696052

Title

President

Phone

(214) 363-5965

Specialties & licenses 1

Addresses

Other names 1

• Dallas Fertility Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samuel John Chantilis, M.D.

  • Reproductive Endocrinology Physician
  • Dallas, TX
  • NPI 1386696052
  NPD (past) Authorized official
• Ravi P Gada, M.D.

  • Reproductive Endocrinology Physician
  • Dallas, TX
  • NPI 1063527588
  NPD (past)
• Laura T Lawrence, M.D.

  • Reproductive Endocrinology Physician
  • Dallas, TX
  • NPI 1346284627
  NPD (past)
• Karen Lynn Lee, M.D.

  • Reproductive Endocrinology Physician
  • Dallas, TX
  • NPI 1114979804
  NPD (past)
• Mika R Thomas, M.D.

  • Reproductive Endocrinology Physician
  • Dallas, TX
  • NPI 1932319209
  NPD (past)

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

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1649585456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5477 GLEN LAKES DR",
            "address_2": "SUITE 201",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752310946",
            "telephone_number": "214-363-5965",
            "fax_number": "214-363-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5477 GLEN LAKES DR",
            "address_2": "SUITE 201",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752310946",
            "telephone_number": "214-363-5965",
            "fax_number": "214-363-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS FORT WORTH IVF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "CHANTILIS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-363-5965",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D1095599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dallas Fertility Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.