NPIMap

Individual provider Active NPI

Prakash Gajera

  • Vascular & Interventional Radiology Physician
  • Tyler, TX
National Provider Identifier
1013448240
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
R9959 Issued in TX
Practice address
627 Turtle Creek Dr
Tyler, TX 75701-1832
Phone
(817) 321-0404
NPI assigned
Mar 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R9959 TX
Student in an Organized Health Care Education/Training Program 390200000X TX
Vascular & Interventional Radiology Physician 2085R0204X R9959 TX Primary

Addresses

Primary practice location

627 Turtle Creek Dr
Tyler, TX 75701-1832

Mailing address

816 W Cannon St
Fort Worth, TX 76104-3146
Phone (817) 321-0404

Other practice location 1

815 Pennsylvania Ave
Fort Worth, TX 76104-2224
Phone (817) 321-0404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230516002946 TX Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 3072979111 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
University of Texas Southwestern Medical School at Dallas, 2017
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

815 Pennsylvania Ave
Fort Worth, TX 76104-2224
Phone (817) 321-0470

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates of North Texas, PA Diagnostic Radiology CurrentSince Apr 11, 2023 Accepting new patients
Btdi JV, LLP CurrentSince Sep 19, 2024 Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Apr 11, 2023 Accepting new patients
Clinical Care in Radiology Past Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

627 Turtle Creek Dr
Tyler, TX 75701
Phone (903) 597-6372

Interoperability endpoints

  • Direct secure messaging: pgajera42434@direct.phhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1013448240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043146",
            "telephone_number": "817-321-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011832",
            "telephone_number": "817-321-0404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761042224",
            "country_code": "US",
            "telephone_number": "817-321-0404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAJERA",
        "first_name": "PRAKASH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R9959",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "R9959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.