South Loop 12 Medical Clinic LLC
NPI 1417034745 · Family Nurse Practitioner · Dallas, TX
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
South Loop 12 Medical Clinic LLC is a Family Nurse Practitioner organization in Dallas, TX (NPI 1417034745).
Provider details
- NPI number
- 1417034745
- Entity type
- Organization
- Primary specialty
- Family Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Connie Nellum, Family Nurse Pactitione Certified(214) 398-4157
- License
- 528675 (TX)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-11-01
- Last updated
- 2014-10-09
Frequently asked questions
- What is South Loop 12 Medical Clinic LLC's NPI number?
- South Loop 12 Medical Clinic LLC's National Provider Identifier (NPI) is 1417034745, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is South Loop 12 Medical Clinic LLC?
- South Loop 12 Medical Clinic LLC is classified in the NPPES registry as Family Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers).
- Where is South Loop 12 Medical Clinic LLC located?
- South Loop 12 Medical Clinic LLC's practice location on file with NPPES is 3232 Great Trinity Forest Way, Dallas, TX 75216-7732.
- What is South Loop 12 Medical Clinic LLC's phone number?
- The practice phone number listed in the NPPES registry for South Loop 12 Medical Clinic LLC is (214) 398-4157.
- Does South Loop 12 Medical Clinic LLC accept Medicare?
- South Loop 12 Medical Clinic LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for South Loop 12 Medical Clinic LLC?
- The authorized official listed on South Loop 12 Medical Clinic LLC's NPPES record is Connie Nellum, Family Nurse Pactitione Certified. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is South Loop 12 Medical Clinic LLC's NPI active?
- Yes — South Loop 12 Medical Clinic LLC's NPI (1417034745) is active in the NPPES registry as of the last update on 2014-10-09.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.