IMMANUEL FAMILY CLINIC PLLC
NPI 1265072490
Nurse Practitioner - Family in Carrollton, TX
About Immanuel Family Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IMMANUEL FAMILY CLINIC PLLC (NPI 1265072490) is a healthcare organization registered as a family in Carrollton, Texas and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through December 1, 2027 and lists Sutha M Fernando, Owner, 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)
Immanuel Family Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Immanuel Family Clinic PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (4)
Carrollton, TX 75006
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 45D2175784
Immanuel Family Clinic · Carrollton, 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 Immanuel Family Clinic PLLC's NPI number?
The NPI number for Immanuel Family Clinic PLLC is 1265072490. It was assigned to this organization in the NPPES registry on January 15, 2020.
Where is Immanuel Family Clinic PLLC located?
Immanuel Family Clinic PLLC is located at 2760 E Trinity Mills Rd Ste 115, Carrollton, TX 75006. The listed phone number is (469) 900-8211.
What is Immanuel Family Clinic PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Immanuel Family Clinic PLLC enrolled in Medicare?
Yes. Immanuel Family Clinic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Immanuel Family Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Immanuel Family Clinic PLLC. 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 at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Immanuel Family Clinic PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D2175784) is associated with this NPI, valid through December 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Immanuel Family Clinic PLLC accept?
Health plans from Molina Healthcare and WellPoint list Immanuel Family Clinic 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 Immanuel Family Clinic PLLC was last updated on February 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Immanuel Family Clinic Pllc · NPI 1265072490
Family organization in Carrollton, Texas. Organization record, active in the CMS NPPES registry since January 15, 2020.
## Identity
- **NPI:** 1265072490 (Entity type: Organization)
- **Enumerated:** January 15, 2020
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Sutha Fernando, OWNER
## Practice location
- **Address:** 2760 E TRINITY MILLS RD STE 115, Carrollton, TX 75006-2194
- **Phone:** (469) 900-8211
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 11, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1265072490) · Data from the CMS NPPES public registry.