Individual provider Active NPI

Shagun Dhaliwal, MD

  • Cornea and External Diseases Specialist Physician
  • Flower Mound, TX
National Provider Identifier
1902211667
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cornea and External Diseases Specialist PhysicianTaxonomy code 207WX0120X
License
R6551 Issued in TX
Practice address
4900 Long Prairie Rd Ste 400
Flower Mound, TX 75028-2234
Phone
(972) 691-3937
NPI assigned
Jun 21, 2014
Last updated
May 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TL.0005331 CO
Ophthalmology Physician 207W00000X R6551 TX
Ophthalmology Physician 207W00000X 10716230-1205 UT
Cornea and External Diseases Specialist Physician 207WX0120X R6551 TX Primary

Addresses

Primary practice location

4900 Long Prairie Rd Ste 400
Flower Mound, TX 75028-2234

Mailing address

4900 Long Prairie Rd Ste 100
Flower Mound, TX 75028-2288
Phone (214) 500-5552

Other practice location 1

11751 Alta Vista Rd Ste 103A
Fort Worth, TX 76244-6442
Phone (972) 691-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180515002624 UT Practitioner - Ophthalmology 4284932708 Reassigns benefits to 2 organizations
I20191001001360 TX Practitioner - Ophthalmology 4284932708 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Texas a & M University System, HSC, College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4900 Long Prairie Rd
Suite 400
Flower Mound, TX 75028-2234
Phone (972) 691-3937

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery89

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6551TXMDOphthalmology Physician
10716230-1205UTMDOphthalmology Physician
TL.0005331COMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
Eye Associates of Texas, PLLC Ophthalmology CurrentSince Jun 3, 2020 Accepting new patients
University of Utah Adult Services CurrentSince Mar 31, 2018 Accepting new patients
Texas Eye Surgeons PA CurrentSince Aug 1, 2019 Accepting new patients
University of Utah CurrentSince Mar 31, 2018 Accepting new patients
University of Utah Adult Services CurrentSince Mar 31, 2018 Accepting new patients
University of Utah CurrentSince Mar 31, 2018 Accepting new patients

Locations

11751 Alta Vista Rd
Ste 103A
Fort Worth, TX 76244
Phone (972) 691-3937

4108 W 15th St
Ste 200
Plano, TX 75093
Phone (972) 379-3937

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: sdhaliwal@directaddress.net

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1403308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1902211667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 LONG PRAIRIE RD STE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750282288",
            "telephone_number": "214-500-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 LONG PRAIRIE RD STE 400",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750282234",
            "telephone_number": "972-691-3937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11751 Alta Vista Rd Ste 103A",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "762446442",
            "country_code": "US",
            "telephone_number": "972-691-3937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DHALIWAL",
        "first_name": "SHAGUN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-21",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0005331",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "R6551",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "10716230-1205",
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "TX",
            "license": "R6551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

Verify at the official NPI Registry.