NPIMap

Organization Active NPI

DFW Family Clinic

  • Family Medicine Physician
  • Grand Prairie, TX
National Provider Identifier
1811228851
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K7396 Issued in TX
Legal business name
DFW FAMILY CLINIC
Practice address
2771 Sherman St
Grand Prairie, TX 75051-6016
Phone
(972) 647-0550
Fax
(972) 647-1010
NPI assigned
Jan 14, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Authorized official

Name
Mrs. Adila Nighat Siddiqi, D.O.NPI 1932180296
Title
Owner
Phone
(972) 647-0550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X K7396 TX Primary

Addresses

Primary practice location

2771 Sherman St
Grand Prairie, TX 75051-6016

Mailing address

2771 Sherman St
Grand Prairie, TX 75051-6016
Phone (972) 647-0550

Other identifiers 3

IdentifierTypeStateIssuer
0076ECOtherTXBLUE CROSS BLUE SHIELD OF TEXAS
OA5881OtherMEDICARE GROUP PTAN #
121398502MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100224000638 TX Part B Supplier - Clinic/Group Practice 7416091772 Receives reassigned benefits from 4 practitioners
Practice locations: Grand Prairie, TX

National Provider Directory

National Provider Directory
Tax ID family
DFW Family Clinic2 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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1263427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1811228851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2771 SHERMAN ST",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750516016",
            "telephone_number": "972-647-0550",
            "fax_number": "972-647-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2771 SHERMAN ST",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750516016",
            "telephone_number": "972-647-0550",
            "fax_number": "972-647-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DFW FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-14",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "SIDDIQI",
        "authorized_official_first_name": "ADILA",
        "authorized_official_middle_name": "NIGHAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-647-0550",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "0076EC",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN #",
            "identifier": "OA5881",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121398502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; 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.