Southlake Orthopedics & Sports Medicine, PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SOUTHLAKE ORTHOPEDICS & SPORTS MEDICINE, PLLC

Practice address

1149 Keller Pkwy Ste a
Keller, TX 76248-1620

Phone

(214) 631-9881

NPI assigned

Jul 22, 2025

Last updated

May 6, 2026By 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

Bantoo Sehgal, MDNPI 1558677690

Title

Owner

Phone

(347) 678-9578

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Southlake Orthopedics & Sports Medicine, PLLC

  dba Summit Orthopedics of Texas

  • Orthopaedic Surgery Physician
  • Fort Worth, TX
  • NPI 1871099739

  8426313131

  Same PAC ID

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.

• Bantoo Sehgal, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Fort Worth, TX
  • NPI 1558677690
  NPD Authorized official
• Paulina Purnama, PA-C

  • Surgical Physician Assistant
  • Fort Worth, TX
  • NPI 1275724981
  NPD

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

{
    "created_epoch": "1753142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1740162726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 12TH AVE STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042519",
            "telephone_number": "214-631-9881",
            "fax_number": "469-482-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 KELLER PKWY STE A",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762481620",
            "telephone_number": "214-631-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE ORTHOPEDICS & SPORTS MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-22",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "SEHGAL",
        "authorized_official_first_name": "BANTOO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-678-9578",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Snow
• Zaynab Ann Sohail
• Jenna Solomon, PA-C
• Meagan Patricia Soltwisch, DNP, FNP-C
• Cara Sloane Souther, RD
• Southwest LTC Keller, LLC (Heritage House of Keller Health & Rehabilitation Center)
• Tanya Spakowski-Lane
• Specialeyes Optical, LLC
• Rayven Denise Tippett Spencer
• Sydney Spiller, CCC-SLP

• Orthopaedic Surgery Physician in Keller, TX
• Providers in Keller, TX by specialty
• Orthopaedic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; 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.