DESOTO HEALTHCARE CLINIC LLC – Primary Care Nurse Practitioner, NPI 1225707342
Primary Care Nurse Practitioner
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DESOTO HEALTHCARE CLINIC LLC
1221 W AIRPORT FWY STE 209
IRVING, TX 750626209
Phone: (469) 567-9974
Fax: (817) 865-1530
Type: Mailing
515 WADE CT
EULESS, TX 760392085
Phone: (682) 558-5993
Type: Mailing
951 YORK DR STE 102
DESOTO, TX 751152052
Phone: (972) 746-7771
Type: Location
860 HEBRON PKWY STE 704
LEWISVILLE, TX 750575145
Phone: (214) 777-2703
Fax: (817) 865-1530
Type: Location
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: 2021-10-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation scheduled
Earliest CMS due date is 2026-10-31 (145 days away).
Enrollment records
1
Earliest due date
2026-10-31
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 |
|---|---|---|---|---|
| O20211020000022 | O | Clinic/Group Practice | TX | 2026-10-31 |
What to do next
- Monitor the published due date as it approaches.
- Plan to revalidate in PECOS within the window CMS allows before the due date.
- Verify the date on the CMS Revalidation Lookup Tool before submitting.
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 75062)
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