NPIMap

Organization Active NPI

Physician Associates of Southwest Dallas

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1801845425
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS
Practice address
122 W Colorado Blvd
Dallas, TX 75208-2382
Phone
(214) 947-6700
Fax
(214) 947-6701
NPI assigned
May 9, 2006
Last updated
Dec 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

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

Authorized official

Name
Dr. Samuel Cullison, MD
Title
Vice President
Phone
(214) 947-2356

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Maternal & Fetal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VM0101X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

122 W Colorado Blvd
Dallas, TX 75208-2382

Mailing address

3400 W Wheatland Rd
BLDG III, Suite 360
Dallas, TX 75237-3460
Phone (214) 884-4700

Other practice location 1

3500 W Wheatland Rd
Dallas, TX 75237-3460
Phone (214) 947-5400

Other identifiers 2

IdentifierTypeStateIssuer
156122702OtherTXMEDICAID TX HEALTH STEPS
156122701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040629000498 TX Part B Supplier - Clinic/Group Practice 3274519293 Receives reassigned benefits from 136 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory
Tax ID family
Physician Assoc of SW Dallas2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

326 Cooper St
Cedar Hill, TX 75104
Phone (262) 422-2508

1135 N Bishop Ave
Dallas, TX 75208
Phone (214) 388-8898

2959 S Buckner Blvd
Dallas, TX 75227
Phone (214) 239-2176

5709 W Lovers Ln
Dallas, TX 75209
Phone (214) 351-1800

221 W Colorado Blvd
Ste 200
Dallas, TX 75208

1441 N Beckley Ave
Ste 4116
Dallas, TX 75203
Phone (214) 947-2385

252 Matlock Rd
Ste 348
Mansfield, TX 76063
Phone (682) 622-0004

Practitioners & affiliated clinicians

Practitioners 174

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.

View all 174

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544659200000",
    "number": "1801845425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W WHEATLAND RD",
            "address_2": "BLDG III, SUITE 360",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373460",
            "telephone_number": "214-884-4700",
            "fax_number": "214-884-4761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W COLORADO BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752082382",
            "telephone_number": "214-947-6700",
            "fax_number": "214-947-6701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 W Wheatland Rd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752373460",
            "country_code": "US",
            "telephone_number": "214-947-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2018-12-13",
        "status": "A",
        "authorized_official_last_name": "CULLISON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "214-947-2356",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID TX HEALTH STEPS",
            "identifier": "156122702",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156122701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.