GRACE SOUTHERN MEDICAL CLINIC, PLLC
NPI 1821486358
Clinic/Center - Primary Care in Dallas, TX
About Grace Southern Medical Clinic, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRACE SOUTHERN MEDICAL CLINIC, PLLC (NPI 1821486358) is a healthcare organization registered as a primary care in Dallas, Texas and active in the NPI registry since January 2015. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Mesquite, and lists Sergio Calixto-montanez, Member, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 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)
Grace Southern Medical Clinic, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Grace Southern Medical Clinic, PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
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 2
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 45D2346610
Grace Southern Medical Clinic PLLC · Mesquite, TXCertificate of Waiver 45D2104254
Grace Southern Medical, PLLC · Dallas, 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 Grace Southern Medical Clinic, PLLC's NPI number?
The NPI number for Grace Southern Medical Clinic, PLLC is 1821486358. It was assigned to this organization in the NPPES registry on January 7, 2015.
Where is Grace Southern Medical Clinic, PLLC located?
Grace Southern Medical Clinic, PLLC is located at 6300 Samuell Blvd Ste 120, Dallas, TX 75228. The listed phone number is (214) 381-1910.
What is Grace Southern Medical Clinic, PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Grace Southern Medical Clinic, PLLC enrolled in Medicare?
Yes. Grace Southern Medical Clinic, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Grace Southern Medical Clinic, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Grace Southern Medical Clinic, PLLC, in Family Practice and Nurse Practitioner. 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, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Grace Southern Medical Clinic, PLLC hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Grace Southern Medical Clinic, PLLC accept?
Health plans from Blue Cross and Blue Shield of Texas, Cigna Healthcare, Molina Healthcare and WellPoint list Grace Southern Medical 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 Grace Southern Medical Clinic, PLLC was last updated on August 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.
# Grace Southern Medical Clinic, Pllc · NPI 1821486358
Primary Care organization in Dallas, Texas. Organization record, active in the CMS NPPES registry since January 7, 2015.
## Identity
- **NPI:** 1821486358 (Entity type: Organization)
- **Enumerated:** January 7, 2015
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Sergio Calixto-Montanez, MEMBER
## Practice location
- **Address:** 6300 SAMUELL BLVD STE 120, Dallas, TX 75228-7100
- **Phone:** (214) 381-1910 · **Fax:** (214) 381-2868
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (2), Nurse Practitioner (1); 2 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 24, 2026
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1821486358) · Data from the CMS NPPES public registry.