Individual provider Active NPI

Leena G Panicker, DNP FNP-C

  • Family Nurse Practitioner
  • Balch Springs, TX
National Provider Identifier
1780037259
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
API130237 Issued in TX
Practice address
11203 Lake June Rd Ste 100
Balch Springs, TX 75180-1304
Phone
(469) 289-7755
NPI assigned
Jul 19, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X API130237 TX Primary

Addresses

Primary practice location

11203 Lake June Rd Ste 100
Balch Springs, TX 75180-1304

Mailing address

11203 Lake June Rd Ste 100
Balch Springs, TX 75180-1304
Phone (469) 289-7755

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161005000688 TX Practitioner - Nurse Practitioner 5193013282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11203 Lake June Rd
Suite 100
Balch Springs, TX 75180-1304
Phone (469) 776-5250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
API130237TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alegria Family Clinic PLLC Single Specialty CurrentSince Aug 30, 2016 Accepting new patients

Locations

11203 Lake June Rd
Ste 100
Balch Springs, TX 75180
Phone (469) 289-7755

2241 Peggy Ln
Ste B
Garland, TX 75042
Phone (972) 205-1047

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1780037259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11203 LAKE JUNE RD STE 100",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751801304",
            "telephone_number": "469-289-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11203 LAKE JUNE RD STE 100",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751801304",
            "telephone_number": "469-289-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANICKER",
        "first_name": "LEENA",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "DNP  FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-19",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "API130237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Balch Springs, TX

Sources for this page

Verify at the official NPI Registry.