Organization Active NPI

North Dallas Primary Care Doctors PLLC

  • Internal Medicine Physician
  • Frisco, TX
National Provider Identifier
1952828279
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
P0418 Issued in TX
Legal business name
NORTH DALLAS PRIMARY CARE DOCTORS PLLC
Practice address
8795 Preston Trace Blvd Ste 100
Frisco, TX 75033-3010
Phone
(214) 705-3728
Fax
(214) 308-9464
NPI assigned
Aug 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

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

Authorized official

Name
Dr. Suchitra Rao Kamineni, MDNPI 1851548622
Title
President
Phone
(214) 705-3728

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X P0418 TX Primary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0002X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Neonatal-Perinatal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080N0001X

Addresses

Primary practice location

8795 Preston Trace Blvd Ste 100
Frisco, TX 75033-3010

Mailing address

8795 Preston Trace Blvd Ste 100
Frisco, TX 75033-3010
Phone (214) 705-3728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171208002269 TX Part B Supplier - Clinic/Group Practice 5799042289 Receives reassigned benefits from 2 practitioners
Practice locations: Frisco, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2143116North Dallas Primary Care Doctors8795 Preston Trace Blvd Suite 100, Frisco, TX 75033Certificate of waiverJan 23, 2028

National Provider Directory

National Provider Directory

Locations

8795 Preston Trace Blvd
#100
Frisco, TX 75033

8795 Preston Trace Blvd
Ste 100
Frisco, TX 75033
Phone (214) 705-3728

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1952828279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8795 PRESTON TRACE BLVD STE 100",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333010",
            "telephone_number": "214-705-3728",
            "fax_number": "214-308-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8795 PRESTON TRACE BLVD STE 100",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333010",
            "telephone_number": "214-705-3728",
            "fax_number": "214-308-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DALLAS PRIMARY CARE DOCTORS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "KAMINENI",
        "authorized_official_first_name": "SUCHITRA",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-705-3728",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "P0418",
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.