MANSFIELD ENDOSCOPY CENTER, LLC
NPI 1366047433
Clinic/Center - Ambulatory Surgical in Mansfield, TX

NPI Status: Active since December 04, 2020

Contact Information

647 N MILLER RD
MANSFIELD, TX
ZIP 76063
Phone: (817) 893-2381

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  • Organization
  • Clinic/Center
  • Ambulatory Surgical
  • Accepts Insurance
  • CLIA Number: 45D2209350
  • CLIA Cert. Type: Ambulatory Surgery Center
  • CLIA Exp. Date: 01-12-2027

About MANSFIELD ENDOSCOPY CENTER, LLC

This page provides the complete NPI Profile along with additional information for Mansfield Endoscopy Center, Llc, a provider established in Mansfield, Texas operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1366047433 assigned on December 2020. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The authorized official of this NPI record is Kelly Rouvaldt (Director Of Asc Operations)

NPI
1366047433
Provider Name
MANSFIELD ENDOSCOPY CENTER, LLC
Entity Type
Organization
Location Address
647 N MILLER RD MANSFIELD, TX 76063
Location Phone
(817) 893-2381
Mailing Address
647 N MILLER RD MANSFIELD, TX 76063
Mailing Phone
(817) 415-9670
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
12-04-2020
Last Update Date
06-29-2022
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Ambulatory Surgical

Taxonomy Code
261QA1903X
Type
Ambulatory Health Care Facilities

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Elite Gold + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Choice Bronze HSA (QualChoice) - POS
  • Complete Gold - PPO
  • Complete Gold + Vision + Adult Dental - PPO
  • Connected Silver - PPO
  • Connected Silver (QualChoice) - POS
  • Connected Silver (QualChoice) + Vision + Adult Dental - POS
  • Connected Silver (QualChoiceLife) - PPO
  • Connected Silver (QualChoiceLife) + Vision + Adult Dental - PPO
  • Connected Silver + Vision + Adult Dental - PPO
  • Elite Bronze - PPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Elite Bronze - EPO
  • Elite Bronze + Vision + Adult Dental - EPO
  • Elite Gold - EPO
  • Elite Gold + Vision + Adult Dental - EPO
  • Everyday Bronze - EPO
  • Everyday Bronze + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Complete Gold - EPO
  • Complete Gold + Vision + Adult Dental - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - EPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
  • Everyday Gold - EPO
  • Everyday Gold + Vision + Adult Dental - EPO
  • Focused Silver - EPO
  • Focused Silver + Vision + Adult Dental - EPO
  • Standard Gold - EPO
  • Standard Gold + Vision + Adult Dental - EPO
  • Elite Bronze - PPO
  • Elite Bronze + Vision + Adult Dental - PPO
  • Elite Gold - PPO
  • Elite Gold + Vision + Adult Dental - PPO
  • Enhanced Asthma/COPD Care Silver with $0 Drug Options - PPO
  • Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
  • Enhanced Diabetes Care Silver with $0 Drug Options - PPO
  • Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - PPO
  • Everyday Bronze - PPO
  • Everyday Bronze + Vision + Adult Dental - PPO
  • MyBlue Health Bronze? 402 - HMO
  • MyBlue Health Bronze? Standard - HMO
  • MyBlue Health Gold? 403 - HMO
  • MyBlue Health Gold? Standard - HMO
  • MyBlue Health Silver? 405 - HMO
  • MyBlue Health Silver? Standard - HMO
  • Imperial Preferred Bronze - HMO
  • Imperial Preferred Gold - HMO
  • Imperial Preferred Gold Zero - HMO
  • Imperial Preferred Silver - HMO
  • Imperial Standard Bronze - HMO
  • Imperial Standard Gold - HMO
  • Imperial Standard Silver - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

KELLY ROUVALDT

Authorized Official Title
DIRECTOR OF ASC OPERATIONS
Authorized Official Phone
(817) 415-9670

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

This service was performed 85 times for 84 patients

Biopsy of large bowel using a flexible endoscope

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

This service was performed 77 times for 77 patients

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

This service was performed 24 times for 24 patients

Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope

This procedure, known as an upper endoscopy, involves inserting a thin, flexible tube with a camera down the throat to examine the esophagus, stomach, and upper small bowel. It helps diagnose conditions like ulcers or inflammation.

This service was performed 11 times for 11 patients

Diagnostic exam of large bowel using a flexible endoscope

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

This service was performed 16 times for 16 patients

Insertion of guide wire with dilation of esophagus using a flexible endoscope

This is a procedure where a thin tube, called an endoscope, is gently passed through your mouth into your esophagus. A guide wire is then inserted to help widen any narrow areas. This helps improve swallowing and reduce discomfort.

This service was performed 21 times for 21 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

This service was performed 91 times for 91 patients

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
45D2209350
Facility Type
Ambulatory Surgery Center
Certificate Effective Date
January 13, 2025
Certificate Expiration Date
January 12, 2027
Laboratory Director
SUWEBATU ODUNSI-SHIYANBADE
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Mansfield Endoscopy Center, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1366047433, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
3
Unchanged
Pos 3
6
Doubled → 12 → 1 + 2
Pos 4
6
Unchanged
Pos 5
0
Doubled → 0
Pos 6
4
Unchanged
Pos 7
7
Doubled → 14 → 1 + 4
Pos 8
4
Unchanged
Pos 9
3
Doubled → 6
Check
3
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 6 → 12 → 3 0 → 0 7 → 14 → 5 3 → 6

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 3 + 1 + 2 + 6 + 0 + 4 + 1 + 4 + 4 + 6 + 24 = 57

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 57 is 60. The difference is the calculated check digit.

60 - 57 = 3
This NPI is valid
The calculated check digit is 3, which matches the last digit of 1366047433.

Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

Nurse Practitioner (Family)
647 N MILLER RD
MANSFIELD, TX 76063

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1366047433, enumerated as an "organization" on December 04, 2020.

The provider is located at 647 N MILLER RD MANSFIELD, TX 76063 and the phone number is (817) 893-2381.

Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.

The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to verify.