Silverlake Professional Group

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

SILVERLAKE PROFESSIONAL GROUP

Doing business as

Silverlake Medical Group
Timber Lake Consulting, LLC

Practice address

2104 Kimball Hill CT
Southlake, TX 76092-7914

Phone

(432) 352-4443

NPI assigned

Nov 8, 2022

Last updated

Nov 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Philip Talley, FNPNPI 1720402365

Title

Owner

Phone

(323) 524-4434

Specialties & licenses 1

Addresses

Other names 2

• Silverlake Medical Group Doing business as
• Timber Lake Consulting, LLC Doing business as

Practitioners 1

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.

• Philip Talley, FNP

  • Family Nurse Practitioner
  • Midland, TX
  • NPI 1720402365
  NPD Authorized official

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1861100976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 KIMBALL HILL CT",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927914",
            "telephone_number": "432-352-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 KIMBALL HILL CT",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927914",
            "telephone_number": "432-352-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVERLAKE PROFESSIONAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-524-4434",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silverlake Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Timber Lake Consulting, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna Maria Shute, FNP-BC
• Talaya Marie Sibley
• Mohammad Zia Siddiqui, MD
• Nicole Siegel, LCSW, LCDC
• Sierra Op TX, LLC (Sierra at Southlake)
• Silverstone Harborchase Southlake Operating, LLC (HarborChase of Southlake)
• Brooke V. Simer, MA, CCC-SLP
• Savannah Simerly
• Brian Marc Simmons, LPC
• Simon S Tan, MD PA

• Geriatric Medicine (Family Medicine) Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Geriatric Medicine (Family Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.