NPIMap

Organization Active NPI

Surgicalist of TX PLLC

  • Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1972048510
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICALIST OF TX PLLC
Practice address
909 9TH Ave Ste 205
Fort Worth, TX 76104-3916
Phone
(972) 665-6501
Fax
(972) 866-4013
NPI assigned
Jan 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

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

Authorized official

Name
Dr. Mit Desai, M.D.
Title
Ceo
Phone
(813) 530-5043

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

909 9TH Ave Ste 205
Fort Worth, TX 76104-3916

Mailing address

PO Box 21647
Tampa, FL 33622-1647
Phone (813) 530-5043

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170209000271 TX Part B Supplier - Clinic/Group Practice 6800179292 Receives reassigned benefits from 8 practitioners
Practice locations: Bryan, TX

National Provider Directory

National Provider Directory

Locations

19105 N US Highway 41
Ste 300
Lutz, FL 33549
Phone (813) 751-0247

909 9th Ave
Ste 205
Fort Worth, TX 76104
Phone (817) 332-0786

Practitioners & affiliated clinicians

Practitioners 9

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": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1972048510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21647",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336221647",
            "telephone_number": "813-530-5043",
            "fax_number": "813-866-1957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 9TH AVE STE 205",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043916",
            "telephone_number": "972-665-6501",
            "fax_number": "972-866-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICALIST OF TX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "MIT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-530-5043",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.