NPIMap

Individual provider Active NPI

Sakthiraj Subramanian, MD

  • Internal Medicine Physician
  • Willow Park, TX
National Provider Identifier
1669676326
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35-088941 Issued in OH
Practice address
5700 E Interstate 20 Service Rd S
Suite 100
Willow Park, TX 76008-5115
Phone
(817) 489-7300
Fax
(181) 748-9730
NPI assigned
Jun 14, 2007
Last updated
Feb 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35-088941 OH Primary

Addresses

Primary practice location

5700 E Interstate 20 Service Rd S
Suite 100
Willow Park, TX 76008-5115

Mailing address

5700 E Interstate 20 Service Rd S
Suite 100
Willow Park, TX 76008-5115
Phone (781) 748-9730

Other identifiers 2

IdentifierTypeStateIssuer
P00462034OtherOHRR MEDICARE
2747184MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address SAKTHIRAJ.SUBRAMANIAN@hca7.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151002002160 TX Practitioner - Internal Medicine 4284728262 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dallas Medical Specialists, PLLCGroup PAC ID 3072895788, 86 clinicians

Practice addresses (Care Compare)

1308 E Paluxy Rd
205 Lonestar Medical General Surgery
Granbury, TX 76048-5689
Phone (817) 489-7450

7777 Forest LN
Suite C300
Dallas, TX 75230-2514
Phone (972) 566-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.02 of 100Reported as individual
Quality
94.05
Promoting interoperability
100
Improvement activities
40
Cost
59.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-088941OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Timberland Medical Group CurrentSince Sep 3, 2015 Accepting new patients
Dallas Medical Specialists, PLLC Internal Medicine CurrentSince Oct 1, 2017 Accepting new patients
Timberland Medical Group Internal Medicine CurrentSince Sep 3, 2015 Accepting new patients
Lonestar Provider Network Internal Medicine Past Accepting new patients
MHS of Texas II, Inc. Past Accepting new patients
Mainstream Habilitation Services of Texas, Inc. Past Accepting new patients

Locations

1401 Medical Pkwy
Bldg B
Cedar Park, TX 78613
Phone (512) 528-7480

7777 Forest Ln
Ste C300
Dallas, TX 75230
Phone (972) 566-6000

1308 Paluxy Rd
Ste 205
Granbury, TX 76048
Phone (817) 489-7450

5700 E Interstate 20 Service Rd S
Ste 100
Willow Park, TX 76008
Phone (817) 489-7300

Interoperability endpoints

  • Direct secure messaging: sakthiraj.subramanian@hca7.eclinicaldirectplus.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1669676326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 E INTERSTATE 20 SERVICE RD S",
            "address_2": "SUITE 100",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760085115",
            "telephone_number": "781-748-9730",
            "fax_number": "181-748-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 E INTERSTATE 20 SERVICE RD S",
            "address_2": "SUITE 100",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760085115",
            "telephone_number": "817-489-7300",
            "fax_number": "181-748-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBRAMANIAN",
        "first_name": "SAKTHIRAJ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-088941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00462034",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2747184",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SAKTHIRAJ.SUBRAMANIAN@hca7.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "5700 E Interstate 20 Service Rd S",
            "address_2": "SUITE 100",
            "city": "Willow Park",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760085115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Willow Park, TX

Sources for this page

Verify at the official NPI Registry.