NPIMap

Individual provider Active NPI

Saravanan Balamuthusamy, M.D.

  • Nephrology Physician
  • Fort Worth, TX
National Provider Identifier
1932395811
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
Q2427 Issued in TX
Practice address
1001 Pennsylvania Ave
Fort Worth, TX 76104-2228
Phone
(817) 877-5858
Fax
(817) 335-4418
NPI assigned
Sep 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 201657 LA
Internal Medicine Physician 207R00000X Q2427 TX
Nephrology Physician 207RN0300X 20565 MS
Nephrology Physician 207RN0300X 43632 AZ
Nephrology Physician 207RN0300X Q2427 TX Primary

Addresses

Primary practice location

1001 Pennsylvania Ave
Fort Worth, TX 76104-2228

Mailing address

1000 W Cannon St
Fort Worth, TX 76104-3029
Phone (817) 877-5858

Other practice location 1

5203 Lake Ridge Pkwy Ste 101
Grand Prairie, TX 75052-3017
Phone (817) 633-9590

Other practice location 2

500 Lipscomb St
Fort Worth, TX 76104-2239
Phone (817) 870-2616

Other identifiers 1

IdentifierTypeStateIssuer
342884901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150202000538 TX Practitioner - NephrologyPractitioner - Internal Medicine 7315034972 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PPG Health PAGroup PAC ID 7113904657, 32 clinicians

Practice addresses (Care Compare)

1001 Pennsylvania Ave
Fort Worth, TX 76104-2228
Phone (817) 877-5907

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43632AZMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PPG Health, PA Internal Medicine CurrentSince Nov 29, 2014 Accepting new patients
PPG Special Procedures, LLC Current Accepting new patients
Acclaim Physician Group, Inc Internal Medicine CurrentSince May 1, 2016 Accepting new patients
Columbia Plaza Medical Center of Fort Worth Subsidiary LP Past Accepting new patients
Pma Medical Treatment Centers, LLC PastSince Jan 1, 2016 Accepting new patients
Clarksdale Hma Physician Management LLC Internal Medicine Past Accepting new patients

Locations

3301 Matlock Rd
Arlington, TX 76015
Phone (682) 509-6200

1001 12th Ave
Ste 102
Fort Worth, TX 76104
Phone (817) 725-7880

3848 North Tarrant Pkwy
Ste 160
Fort Worth, TX 76244
Phone (817) 725-7880

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1350 S Main St
Ste 3200
Fort Worth, TX 76104
Phone (817) 338-4550

9990 Dallas Pkwy
Ste 105
Frisco, TX 75033
Phone (972) 596-5225

1001 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 618-9997

1661 Eastchase Pkwy
Ft Worth, TX 76120
Phone (682) 250-5700

500 Lipscomb St
Ft Worth, TX 76104
Phone (817) 870-2616

1000 W Cannon St
Ft Worth, TX 76104
Phone (817) 725-7900

9947 N MacArthur Blvd
Ste 150
Irving, TX 75063
Phone (817) 406-2064

5655 W Spring Creek Pkwy
Plano, TX 75024
Phone (972) 566-9600

Interoperability endpoints

  • Direct secure messaging: sbalamuthusamy459424@direct.sw.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1190592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1932395811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043029",
            "telephone_number": "817-877-5858",
            "fax_number": "817-335-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042228",
            "telephone_number": "817-877-5858",
            "fax_number": "817-335-4418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5203 Lake Ridge Pkwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750523017",
            "country_code": "US",
            "telephone_number": "817-633-9590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Lipscomb St",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761042239",
            "country_code": "US",
            "telephone_number": "817-870-2616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALAMUTHUSAMY",
        "first_name": "SARAVANAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-24",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "201657",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "Q2427",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MS",
            "license": "20565",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AZ",
            "license": "43632",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "Q2427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342884901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.