Radiance Wellness Medispa – Clinic/Center, NPI 1639276843
Clinic/Center
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Radiance Wellness Medispa
1825 E Southlake Blvd
Southlake, TX 760926501
Phone: (817) 904-8830
Fax: (817) 467-5819
Type: Location
2301 S Hampton Rd Ste 500
Dallas, TX 752241654
Phone: (214) 330-3937
Fax: (214) 330-3939
Type: Location
3645 Dallas Pkwy Ste 545
Plano, TX 750938167
Phone: (817) 784-0222
Fax: (817) 467-5819
Type: Location
2007 N Jefferson Ave
Mount Pleasant, TX 754552336
Phone: (817) 784-0222
Fax: (817) 467-5819
Type: Location
505 N Gun Barrel Ln
Gun Barrel City, TX 751563732
Phone: (817) 784-0222
Fax: (817) 467-5819
Type: Location
5494 Glen Lakes Dr
Dallas, TX 752314308
Phone: (817) 784-0222
Fax: (817) 467-5819
Type: Location
PO BOX 200438
DALLAS, TX 753200438
Phone: (817) 784-0222
Fax: (817) 467-5819
Type: Mailing
102, East Mexico Avenue, Platt Park, Denver, Denver County, Colorado, 80210, United States
DENVER, CO 802103941
Phone: (303) 800-2078
Fax: (303) 800-2078
Type: Mailing
350, East Interstate 20, Southland Acres, Arlington, Tarrant County, Texas, 76018, United States
ARLINGTON, TX 76018
Phone: (817) 784-0222
Fax: (817) 467-5819
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: 2003-12-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20031216000677 | O | Clinic/Group Practice | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 76092)
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