Southwest Family Practice Clinic – Family Medicine Physician, NPI 1215935234
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Southwest Family Practice Clinic
2600 Saint Michael Dr
Texarkana, TX 755032372
Phone: (903) 614-1000
Type: Location
1000 Pine St
Texarkana, TX 755015100
Phone: (479) 966-4311
Type: Location
3417 U OF A WAY
TEXARKANA, AR 718541419
Phone: (870) 779-6000
Fax: (870) 779-6093
Type: Location
300, East 6th Street, Texarkana, Miller County, Arkansas, 71854, United States
TEXARKANA, AR 718545207
Phone: (870) 779-6000
Fax: (870) 779-6093
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-03-31 (67 days ago).
Enrollment records
2
Earliest due date
2026-03-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040129001063 | O | Clinic/Group Practice | AR | 2026-08-31 |
| O20040513000990 | O | Clinic/Group Practice | TX | 2026-03-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75503)
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