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WATER LEAF SURGERY CENTER MANAGEMENT LLC
NPI 1164942157
Electrodiagnostic Medicine in Ft Worth, TX

Active since June 21, 2017CLIA 45D2118038 · Waiver
111 BOLAND ST STE 211, FT WORTH, TX 76107(214) 269-3875(903) 328-6568 Get Directions Write a Review

NPPES record last updated: June 21, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Water Leaf Surgery Center Management Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WATER LEAF SURGERY CENTER MANAGEMENT LLC (NPI 1164942157) is a healthcare organization registered as an electrodiagnostic medicine in Ft Worth, Texas and active in the NPI registry since June 2017. The organization holds a CLIA Waiver certificate valid through August 28, 2026 and lists Gina Sullivan, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1164942157
Entity TypeOrganization
Primary Taxonomy204R00000X
Legal Business NameWATER LEAF SURGERY CENTER MANAGEMENT LLC
Location Address111 BOLAND ST STE 211Ft Worth, TX 76107-1265
Mailing Address5200 Davis Ln Ste B200Austin, TX 78749-4069
Phone(214) 269-3875
Fax(903) 328-6568
Organization SubpartNo
Authorized OfficialGina SullivanBilling Manager · (214) 269-3875
Enumeration DateJune 21, 2017
✔ NPI 1164942157 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyElectrodiagnostic MedicineAllopathic & Osteopathic Physicians
Taxonomy Code204R00000X
Definition
Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairments of the neurologic, neuromuscular, and/or muscular systems. Qualified physicians are trained in performing electrophysiological testing and interpretation of the test data. They require knowledge in anatomy, physiology, kinesiology, histology, and pathology of the brain, spinal cord, autonomic nerves, cranial nerves, peripheral nerves, neuromuscular junction, and muscles. They must know clinical features and treatment of diseases of the central, peripheral, and autonomic nervous systems, as well as those of neuromuscular junction and muscle. Physicians also require special knowledge about electric signal processing, including waveform analysis, electronics and instrumentation, stimulation and recording equipment, and statistics.
111 BOLAND ST STE 211, Ft Worth, TX 76107
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 45D2118038

Water Leaf Surgery Center · Austin, TX
Active · expires Aug 28, 2026
CLIA Number45D2118038
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateAugust 29, 2024
Certificate Expiration DateAugust 28, 2026
Laboratory DirectorJeraka Rossow
Laboratory Phone(512) 834-4141
Laboratory LocationWater Leaf Surgery Center5200 B Davis Lane, Suite 100 Attn Clia Lab Director, Austin, TX 78749
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRAVO IOM LLC
Electrodiagnostic Medicine
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488
CANDANCE PITTS
Specialist/Technologist, Other (Electroneurodiagnostic)
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488
KEYSTONE NEURO LLC
Electrodiagnostic Medicine
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488
MAS MONITORING LLC
Electrodiagnostic Medicine
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488
WILLIAM BRATCHER JR.
Specialist/Technologist, Other
111 BOLAND ST STE 211
FORT WORTH, TX 76107
Tarrant County (817) 529-8514
SASA RX LLC
Electrodiagnostic Medicine
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488
SURE HEALTH NEUROMONITORING LLC
Electrodiagnostic Medicine
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8500
JASON MOLINARO BS, IONM
Specialist/Technologist, Other (Electroneurodiagnostic)
111 BOLAND ST STE 211
FT WORTH, TX 76107
Tarrant County (817) 529-8488

Frequently 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 Water Leaf Surgery Center Management LLC's NPI number?

The NPI number for Water Leaf Surgery Center Management LLC is 1164942157. It was assigned to this organization in the NPPES registry on June 21, 2017.

Where is Water Leaf Surgery Center Management LLC located?

Water Leaf Surgery Center Management LLC is located at 111 Boland St Ste 211, Ft Worth, TX 76107. The listed phone number is (214) 269-3875.

What is Water Leaf Surgery Center Management LLC's specialty?

The primary specialty registered for this NPI is Electrodiagnostic Medicine with taxonomy code 204R00000X.

Does Water Leaf Surgery Center Management LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2118038) is associated with this NPI, valid through August 28, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Water Leaf Surgery Center Management LLC was last updated on June 21, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.