NPIMap

Organization Active NPI

Sundance Physical Medicine PLLC

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1831811918
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SUNDANCE PHYSICAL MEDICINE PLLC
Practice address
1400 W 7TH St Ste 450
Fort Worth, TX 76102-2601
Phone
(817) 935-8200
Fax
(817) 887-2052
NPI assigned
Sep 14, 2022
Last updated
Oct 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Authorized official

Name
Ms. Gennie Budet
Title
Credentialing Director
Phone
(702) 462-9729

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Internal Medicine Physician 207R00000X Primary
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

1400 W 7TH St Ste 450
Fort Worth, TX 76102-2601

Mailing address

3829 Cathedral Lake Dr
Frisco, TX 75034-3871
Phone (337) 255-7011

National Provider Directory

National Provider Directory

Locations

1400 W 7th St
Ste 450
Fort Worth, TX 76102
Phone (817) 935-8200

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1831811918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3829 CATHEDRAL LAKE DR",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750343871",
            "telephone_number": "337-255-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W 7TH ST STE 450",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761022601",
            "telephone_number": "817-935-8200",
            "fax_number": "817-887-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE PHYSICAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "BUDET",
        "authorized_official_first_name": "GENNIE",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "702-462-9729",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.