NPIMap

Organization Active NPI

Khuong Phan, D.O., P.a.

Doing business as Mansfield Medical Associates

  • Internal Medicine Physician
  • Mansfield, TX
National Provider Identifier
1710006556
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L7520 Issued in TX
Legal business name
KHUONG PHAN, D.O., P.A.
Doing business as
Mansfield Medical Associates
Practice address
920 Highway 287 N
Suite 308
Mansfield, TX 76063-2627
Phone
(817) 473-7197
Fax
(817) 473-7197
NPI assigned
Mar 29, 2007
Last updated
Apr 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Khuong Phan, D.O.NPI 1033119540
Title
Owner
Phone
(817) 473-7197

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L7520 TX Primary

Addresses

Primary practice location

920 Highway 287 N
Suite 308
Mansfield, TX 76063-2627

Mailing address

920 Highway 287 N
Ste. 308
Mansfield, TX 76063-2627
Phone (817) 473-7197

Other identifiers 1

IdentifierTypeStateIssuer
180563202MedicaidTX

Other names 1

  • Mansfield Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070918000441 TX Part B Supplier - Clinic/Group Practice 9234223579 Receives reassigned benefits from 10 practitioners
Practice locations: Mansfield, TX; Arlington, TX

National Provider Directory

National Provider Directory

Locations

920 Highway 287 N
Mansfield, TX 76063
Phone (817) 473-7197

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1710006556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 HIGHWAY 287 N",
            "address_2": "STE. 308",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632627",
            "telephone_number": "817-473-7197",
            "fax_number": "817-473-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 HIGHWAY 287 N",
            "address_2": "SUITE 308",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632627",
            "telephone_number": "817-473-7197",
            "fax_number": "817-473-7197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHUONG PHAN, D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "KHUONG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-473-7197",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L7520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180563202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mansfield Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2008; 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.