Individual provider Active NPI

Taryn Powell Sandvig

  • Family Nurse Practitioner
  • Mineral Wells, TX
National Provider Identifier
1922725456
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1097045 Issued in TX
Practice address
400 SW 25TH Ave
Mineral Wells, TX 76067-8246
Phone
(940) 325-7891
NPI assigned
Oct 25, 2022
Last updated
Oct 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1097045 TX Primary

Addresses

Primary practice location

400 SW 25TH Ave
Mineral Wells, TX 76067-8246

Mailing address

400 SW 25TH Ave
Mineral Wells, TX 76067-8246
Phone (817) 565-3533

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240412002108 TX Practitioner - Nurse Practitioner 2062851876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Medical Group of Texas PLLCGroup PAC ID 7810117223, 319 clinicians

Practice addresses (Care Compare)

400 SW 25TH Ave
Mineral Wells, TX 76067-8246
Phone (940) 325-7891

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1097045TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group of Texas PLLC CurrentSince Apr 4, 2024 Accepting new patients

Locations

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

400 SW 25th Ave
Mineral Wells, TX 76067
Phone (940) 325-7891

Organizations & group practices 1

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": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1922725456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SW 25TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760678246",
            "telephone_number": "817-565-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SW 25TH AVE",
            "city": "MINERAL WELLS",
            "state": "TX",
            "postal_code": "760678246",
            "telephone_number": "940-325-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDVIG",
        "first_name": "TARYN",
        "middle_name": "POWELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1097045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineral Wells, TX

Sources for this page

Verify at the official NPI Registry.