Christine Mandana Tavakoli, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T3709 Issued in TX

Practice address

1940 Enchanted Way Ste 101
Grapevine, TX 76051-0965

Phone

(888) 854-1397

Fax

(469) 699-0240

NPI assigned

May 2, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment NPD
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment NPD

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636243200000",
    "number": "1932554581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 ENCHANTED WAY STE 101",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760510965",
            "telephone_number": "888-854-1397",
            "fax_number": "469-699-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 ENCHANTED WAY STE 101",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760510965",
            "telephone_number": "888-854-1397",
            "fax_number": "469-699-0240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3630 N Shiloh Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Garland",
            "state": "TX",
            "postal_code": "750446630",
            "country_code": "US",
            "telephone_number": "888-854-1397",
            "fax_number": "469-699-0240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAVAKOLI",
        "first_name": "CHRISTINE",
        "middle_name": "MANDANA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-02",
        "last_updated": "2021-11-07",
        "certification_date": "2021-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "OK6263",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T3709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Yuh Tang, M.D.
• Tanya Alexander
• Zachary Tarbet
• Lindsey Tardif, PHD
• Marisol Tarin
• Orquidea D Tavarez
• Taylor R. Brooks, O.D, P.C
• Diana Hopkins Taylor, NP
• Matthew Ford Taylor, DPT
• Tbi Centers PLLC

• Family Medicine Physician in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.