Individual provider Active NPI

Tracey Angadicheril

  • Family Medicine Physician
  • Galveston, TX
National Provider Identifier
1811307473
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q9942 Issued in TX
Practice address
301 University Blvd
Galveston, TX 77555-1250
Phone
(409) 744-4030
Fax
(409) 740-4187
NPI assigned
May 5, 2014
Last updated
Mar 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Q9942 TX Primary

Addresses

Primary practice location

301 University Blvd
Galveston, TX 77555-1250

Mailing address

301 University Blvd
Galveston, TX 77555-1250
Phone (409) 744-4030

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tangadicheril297272@direct.sw.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170922001787 TX Practitioner - Family Practice 6709150147 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)

4001 Worth St
Dallas, TX 75246-1608

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8518
Phone (817) 921-6166

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Oct 30, 2017 Accepting new patients
Healthtexas Provider Network Family Medicine CurrentSince Oct 30, 2017 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients
Healthtexas Provider Network Family Medicine Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

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

900 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 921-6166

Interoperability endpoints

  • Direct secure messaging: tangadicheril297272@direct.sw.org

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 1

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": "1647993600000",
    "number": "1811307473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775551250",
            "telephone_number": "409-744-4030",
            "fax_number": "409-740-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775551250",
            "telephone_number": "409-744-4030",
            "fax_number": "409-740-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGADICHERIL",
        "first_name": "TRACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-05",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q9942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tangadicheril297272@direct.sw.org",
            "affiliation": "N",
            "address_1": "900 W Magnolia Ave Ste 201",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761048518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Galveston, TX

Sources for this page

Verify at the official NPI Registry.