Individual provider Active NPI

Thomas Slack

  • Physical Therapist
  • Dallas, TX
National Provider Identifier
1649948399
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
12747 Midway Rd Ste 150
Dallas, TX 75244-6304
Phone
(972) 979-6577
NPI assigned
Aug 30, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

12747 Midway Rd Ste 150
Dallas, TX 75244-6304

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210922000008 TX Practitioner - Physical Therapist in Private Practice 4789081506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ideal Physical Therapy of Texas LLCGroup PAC ID 0547583809, 359 clinicians

Practice addresses (Care Compare)

9613 Coit Rd
Suite 110
Plano, TX 75024-7378
Phone (945) 544-4792

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Aug 18, 2021 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Aug 18, 2021 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

106 N Denton Tap Rd
Ste 220
Coppell, TX 75019
Phone (469) 528-6437

12747 Midway Rd
Ste 150
Dallas, TX 75244
Phone (469) 872-4562

6333 E Mockingbird Ln
Ste 139
Dallas, TX 75214
Phone (469) 782-7786

6029 Forest Ln
Dallas, TX 75230
Phone (469) 872-7548

9660 Audelia Rd
Ste 101
Dallas, TX 75238
Phone (214) 273-0510

14999 Preston Rd
Ste 108C
Dallas, TX 75254
Phone (214) 231-4154

4015 Lemmon Ave
Dallas, TX 75219
Phone (469) 872-7461

2600 W 7th St
Ste 137
Fort Worth, TX 76107
Phone (682) 233-6462

6420 N MacArthur Blvd
Ste 130
Irving, TX 75039
Phone (972) 402-8300

9613 Coit Rd
Ste 110
Plano, TX 75024
Phone (945) 544-4792

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1649948399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12747 MIDWAY RD STE 150",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752446304",
            "telephone_number": "972-979-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.