SOUTHLAKE PHYSICAL MEDICINE PLLC
NPI 1083088900
Internal Medicine in Southlake, TX
About Southlake Physical Medicine Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTHLAKE PHYSICAL MEDICINE PLLC (NPI 1083088900) is a healthcare organization registered as an internal medicine in Southlake, Texas and active in the NPI registry since November 2015. The organization holds a CLIA Waiver certificate valid through January 4, 2027 and lists Gary Tigges, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Southlake Physical Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Southlake Physical Medicine PLLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D2123948
Southlake Physical Medicine, PLLC · Southlake, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Southlake Physical Medicine PLLC's NPI number?
The NPI number for Southlake Physical Medicine PLLC is 1083088900. It was assigned to this organization in the NPPES registry on November 16, 2015.
Where is Southlake Physical Medicine PLLC located?
Southlake Physical Medicine PLLC is located at 1500 W Southlake Blvd Suite 120, Southlake, TX 76092. The listed phone number is (817) 416-6116.
What is Southlake Physical Medicine PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Southlake Physical Medicine PLLC enrolled in Medicare?
Yes. Southlake Physical Medicine PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southlake Physical Medicine PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Southlake Physical Medicine PLLC, in Chiropractic and Physical Medicine and Rehabilitation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southlake Physical Medicine PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D2123948) is associated with this NPI, valid through January 4, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southlake Physical Medicine PLLC accept?
Health plans from Molina Healthcare and WellPoint list Southlake Physical Medicine PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southlake Physical Medicine PLLC was last updated on April 29, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Southlake Physical Medicine Pllc · NPI 1083088900
Internal Medicine organization in Southlake, Texas. Organization record, active in the CMS NPPES registry since November 16, 2015.
## Identity
- **NPI:** 1083088900 (Entity type: Organization)
- **Enumerated:** November 16, 2015
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Gary Tigges, MEDICAL DIRECTOR
## Practice location
- **Address:** 1500 W SOUTHLAKE BLVD, SUITE 120, Southlake, TX 76092-5950
- **Phone:** (817) 416-6116
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Chiropractic (1), Physical Medicine and Rehabilitation (1); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 29, 2016
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1083088900) · Data from the CMS NPPES public registry.