NPIMap

Individual provider Active NPI

Thanuja D Chandrasena, D.O.

  • Family Medicine Physician
  • Grand Prairie, TX
National Provider Identifier
1780094458
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R3046 Issued in TX
Practice address
4927 Lake Ridge Pkwy Ste 100
Grand Prairie, TX 75052-3060
Phone
(469) 506-1671
NPI assigned
May 5, 2014
Last updated
May 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TX
Family Medicine Physician 207Q00000X R3046 TX Primary

Addresses

Primary practice location

4927 Lake Ridge Pkwy Ste 100
Grand Prairie, TX 75052-3060

Mailing address

4927 Lake Ridge Pkwy Ste 100
Grand Prairie, TX 75052-3060
Phone (469) 506-1671

Other identifiers 4

IdentifierTypeStateIssuer
372918801MedicaidTX
372918802MedicaidTX
200716360AMedicaidOK
29234808MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170711001827 TX Practitioner - Family Practice 1355648817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

2460 N Ih 35E
100 Baylor Scott and White
Waxahachie, TX 75165-5267
Phone (469) 800-9500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
R3046TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Aug 14, 2023 Accepting new patients
Healthtexas Provider Network Family Medicine CurrentSince Aug 14, 2023 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients
Healthtexas Provider Network Family Medicine Past Accepting new patients

Locations

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

4927 Lake Ridge Pkwy
Ste 100
Grand Prairie, TX 75052
Phone (913) 669-3321

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

2460 N Interstate Highway 35 E
Ste 100
Waxahachie, TX 75165
Phone (469) 800-9500

Interoperability endpoints

  • Direct secure messaging: tchandrasena1203596@direct.sw.org
  • Direct secure messaging: thanujachandrasena@ttuhsc.allscriptsdirect.net

Organizations & group practices 4

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1399248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1780094458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523060",
            "telephone_number": "469-506-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4927 LAKE RIDGE PKWY STE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523060",
            "telephone_number": "469-506-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDRASENA",
        "first_name": "THANUJA",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R3046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372918801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372918802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200716360A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29234808",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.