Individual provider Active NPI

Yisa Tunde Sulaiman Jr. Jr., FNP-C

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1932772043
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1047264 Issued in TX
Practice address
15212 Montfort Rd Ste 309
Dallas, TX 75248-6456
Phone
(972) 637-8663
NPI assigned
Jul 19, 2021
Last updated
Jul 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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 1047264 TX Primary

Addresses

Primary practice location

15212 Montfort Rd Ste 309
Dallas, TX 75248-6456

Mailing address

15212 Montfort Rd Ste 309
Dallas, TX 75248-6456
Phone (972) 637-8663

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
I20221123002382 TX Practitioner - Nurse Practitioner 0840668778 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Doctx3 PLLCGroup PAC ID 1355620055, 85 clinicians

Practice addresses (Care Compare)

2419 W Southlake Blvd
100 Direct Orthopedic Care
Southlake, TX 76092-1505
Phone (469) 535-6842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1047264TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Citra Physician Services PLLC CurrentSince Oct 1, 2022 Accepting new patients
Citra Physician Services PLLC CurrentSince Oct 1, 2022 Accepting new patients
Summit Emergency Medicine, PLLC Current Accepting new patients
Swiftcare Urgent Care, PLLC CurrentSince Dec 21, 2022 Accepting new patients
Citra Physician Services PLLC Current Accepting new patients
Total MD Physicians Group, PLLC CurrentSince Aug 12, 2022 Accepting new patients

Locations

8300 N Lamar Blvd
Ste 200A
Austin, TX 78753
Phone (512) 575-9555

18101 Preston Rd
Ste 201
Dallas, TX 75252
Phone (972) 533-8556

3414 Milton Ave
Dallas, TX 75205
Phone (214) 368-4822

6176 Retail Rd
Ste 400
Dallas, TX 75231
Phone (214) 977-6798

7515 Greenville Ave
Ste 900
Dallas, TX 75231
Phone (214) 206-1447

1201 N Main St
Ste 600
Euless, TX 76039
Phone (682) 738-3460

2501 W 7th St
Ste 101
Ft Worth, TX 76107
Phone (817) 268-9690

606 Grapevine Hwy
Ste B
Hurst, TX 76054
Phone (682) 477-3087

234 W Campbell Rd
Richardson, TX 75080
Phone (972) 474-3221

2175 E Southlake Blvd
Ste 120
Southlake, TX 76092
Phone (817) 813-2700

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": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1932772043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15212 MONTFORT RD STE 309",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752486456",
            "telephone_number": "972-637-8663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15212 MONTFORT RD STE 309",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752486456",
            "telephone_number": "972-637-8663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULAIMAN JR.",
        "first_name": "YISA",
        "middle_name": "TUNDE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1047264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.