365 Spine Care of North Texas, PLLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

M8573 Issued in TX

Legal business name

365 SPINE CARE OF NORTH TEXAS, PLLC

Practice address

8080 Independence Pkwy Ste 230
Plano, TX 75025-4013

Phone

(469) 693-0165

NPI assigned

Jan 9, 2018

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kendall Edward Carll II, MDNPI 1063596997

Title

Owner/Manager

Phone

(469) 693-0165

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Practitioners 2

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.

• Kendall Edward Carll II, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Plano, TX
  • NPI 1063596997
  Medicare reassignment Care Compare group NPD Authorized official
• Tricia Nicole Mewbourne, PA

  • Surgical Physician Assistant
  • Plano, TX
  • NPI 1790889004
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1730696956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8080 INDEPENDENCE PKWY STE 230",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750254013",
            "telephone_number": "469-693-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8080 INDEPENDENCE PKWY STE 230",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750254013",
            "telephone_number": "469-693-0165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 Adriatic Pkwy",
            "address_purpose": "LOCATION",
            "city": "McKinney",
            "state": "TX",
            "postal_code": "750708278",
            "country_code": "US",
            "telephone_number": "469-998-2273",
            "fax_number": "469-998-2272",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4461 Coit Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Frisco",
            "state": "TX",
            "postal_code": "750350522",
            "country_code": "US",
            "telephone_number": "469-998-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8080 Independence Pkwy Ste 110",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750254004",
            "country_code": "US",
            "telephone_number": "469-998-2273",
            "fax_number": "469-998-2272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "365 SPINE CARE OF NORTH TEXAS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-09",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "CARLL",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "469-693-0165",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "TRN6843",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "TX",
            "license": "M8573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery of the Spine Physician in Plano, TX
• Providers in Plano, TX by specialty
• Orthopaedic Surgery of the Spine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.