NPIMap

Organization Active NPI

Prodigy Wellness PLLC

  • Specialist
  • Frisco, TX
National Provider Identifier
1780043695
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
Q6046 Issued in TX
Legal business name
PRODIGY WELLNESS PLLC
Practice address
4040 Legacy Dr
Suite 204
Frisco, TX 75034-6748
Phone
(585) 978-0796
NPI assigned
Feb 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

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

Authorized official

Name
Dr. Samad Khan, MD
Title
Owner
Phone
(585) 978-0796

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Q6046 TX Primary

Addresses

Primary practice location

4040 Legacy Dr
Suite 204
Frisco, TX 75034-6748

Mailing address

4040 Legacy Dr
Suite 204
Frisco, TX 75034-6748
Phone (585) 978-0796

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455840000000",
    "number": "1780043695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 LEGACY DR",
            "address_2": "SUITE 204",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346748",
            "telephone_number": "585-978-0796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 LEGACY DR",
            "address_2": "SUITE 204",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346748",
            "telephone_number": "585-978-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-19",
        "last_updated": "2016-02-19",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SAMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-978-0796",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "Q6046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.