Individual provider Active NPI

Gregory Steven Lark

  • Physical Therapist
  • Dallas, TX
National Provider Identifier
1659976793
Registry record updated Dec 4, 2020
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
Dec 4, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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
I20201228000562 TX Practitioner - Physical Therapist in Private Practice 3173936762 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
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)

12747 Midway Rd
Suite 150
Dallas, TX 75244-6304
Phone (972) 979-6577

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 Nov 10, 2020 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Nov 10, 2020 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

9291 Garland Rd
Ste 110
Dallas, TX 75218
Phone (972) 892-4541

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

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

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

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

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

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

1515 N Town East Blvd
Ste 500
Mesquite, TX 75150
Phone (214) 273-2903

1450 E Belt Line Rd
Ste 200
Richardson, TX 75081
Phone (214) 210-4409

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": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1659976793",
    "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": "LARK",
        "first_name": "GREGORY",
        "middle_name": "STEVEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "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 Dec 4, 2020; 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.