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LAKE DALLAS FAMILY MEDICINE PLLC
NPI 1871158907
Nurse Practitioner - Family in Lake Dallas, TX

Active since May 03, 2019CLIA 45D2171260 · Waiver
503 MAIN ST STE C, LAKE DALLAS, TX 75065(940) 535-5296(940) 535-5297 Get Directions Write a Review

NPPES record last updated: June 19, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 19, 2019, May 3, 2019 (2 updates tracked since 2019).

About Lake Dallas Family Medicine Pllc NPPES

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

LAKE DALLAS FAMILY MEDICINE PLLC (NPI 1871158907) is a healthcare organization registered as a family in Lake Dallas, Texas and active in the NPI registry since May 2019. The organization holds a CLIA Waiver certificate valid through August 27, 2027 and lists Carmen Phillips White, Owner, as its authorized official.

NPPES Registry Identity

NPI1871158907
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameLAKE DALLAS FAMILY MEDICINE PLLC
Location Address503 MAIN ST STE CLake Dallas, TX 75065-2878
Mailing Address503 Main St Ste CLake Dallas, TX 75065-2878 · (940) 535-5296 · Fax (940) 535-5297
Phone(940) 535-5296
Fax(940) 535-5297
Organization SubpartNo
Authorized OfficialCarmen Phillips WhiteOwner · (214) 908-6012
Enumeration DateMay 3, 2019
Last NPPES UpdateJune 19, 20192 updates tracked since enumeration
✔ NPI 1871158907 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Also ListedFamily MedicineTaxonomy 207Q00000X
503 MAIN ST STE C, Lake Dallas, TX 75065
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.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)

Lake Dallas Family Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Lake Dallas Family Medicine PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Carmen Phillips White, FNP-BC
Nurse Practitioner
NPI 1689831562
503 MAIN ST STE C
Lake Dallas, TX 75065
(940) 535-5296
✔ PECOS✔ Accepts MedicareSame address
Madisen Stacks
Nurse Practitioner
NPI 1063004158
503 MAIN ST STE C
Lake Dallas, TX 75065
(940) 535-5296
✔ PECOS✔ Accepts MedicareSame address

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 45D2171260

Lake Dallas Family Medicine, PLLC · Lake Dallas, TX
Active · expires Aug 27, 2027
CLIA Number45D2171260
Laboratory TypePractitioner Other
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorCarmen Phillips-White
Laboratory Phone(940) 535-5296
Laboratory LocationLake Dallas Family Medicine, PLLC503 Main St Suite C, Lake Dallas, TX 75065
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Lake Dallas Family Medicine PLLC's NPI number?

The NPI number for Lake Dallas Family Medicine PLLC is 1871158907. It was assigned to this organization in the NPPES registry on May 3, 2019.

Where is Lake Dallas Family Medicine PLLC located?

Lake Dallas Family Medicine PLLC is located at 503 Main St Ste C, Lake Dallas, TX 75065. The listed phone number is (940) 535-5296.

What is Lake Dallas Family Medicine PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Lake Dallas Family Medicine PLLC enrolled in Medicare?

Yes. Lake Dallas Family Medicine PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake Dallas Family Medicine PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Lake Dallas Family Medicine 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lake Dallas Family Medicine PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2171260) is associated with this NPI, valid through August 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lake Dallas Family Medicine PLLC accept?

Health plans from Blue Cross and Blue Shield of Texas list Lake Dallas Family 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 Lake Dallas Family Medicine PLLC was last updated on June 19, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.