Baylor Surgicare at North Dallas, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

007298 Issued in TX

Legal business name

BAYLOR SURGICARE AT NORTH DALLAS, LLC

Practice address

12230 Coit Rd
Ste 200
Dallas, TX 75251-2322

Phone

(469) 374-6400

Fax

(469) 374-6419

NPI assigned

Apr 21, 2006

Organization subpart

No

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

Authorized official

Name

Peter Blach

Title

Officer, Authorized Official

Phone

(713) 343-0832

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Baylor Scott & White Surgicare-North Dallas Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Listed as

Baylor Surgicare at North Dallas LLC Dba Baylor Scott and White Surgicare North DallasCCN 45C0001133

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Baylor University Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1447250253

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1750347472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14201 DALLAS PKWY",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752542916",
            "telephone_number": "469-374-6400",
            "fax_number": "469-374-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12230 COIT RD",
            "address_2": "STE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512322",
            "telephone_number": "469-374-6400",
            "fax_number": "469-374-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYLOR SURGICARE AT NORTH DALLAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "BLACH",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OFFICER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-343-0832"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "007298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z04511337",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085920901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490005465",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Baylor Scott & White Surgicare-North Dallas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Baylor Research Institute
• Baylor Scott & White Health Enterprises, Inc.
• Baylor Scott & White Health Enterprises, Inc.
• Baylor Scott & White Health Enterprises, Inc.
• Baylor Specialty Health Centers
• Baylor University Medical Center
• Baylor University Medical Center
• Baylor University Medical Center
• Baylor University Medical Center
• Baylor University Medical Center

• Ambulatory Surgical Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Ambulatory Surgical Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.