Individual provider Active NPI

Jessica Grace Nordstrom, M.D.

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1023058815
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
L9399 Issued in TX
Practice address
4161 McKinney Ave Ste 300
Dallas, TX 75204-8233
Phone
(972) 817-7040
Fax
(972) 817-7050
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X L9399 TX Primary

Addresses

Primary practice location

4161 McKinney Ave Ste 300
Dallas, TX 75204-8233

Mailing address

4161 McKinney Ave Ste 300
Dallas, TX 75204-8233
Phone (972) 817-7040

Other identifiers 4

IdentifierTypeStateIssuer
1670515-02MedicaidTX
8J1473OtherTXBCBS
167051503MedicaidTX
8BR066OtherTXBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jnordstrom1351324@direct.sw.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040803000405 TX Practitioner - Internal Medicine 7416928676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Texas Tech University Health Science Center School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

4161 McKinney Ave
Suite 300
Dallas, TX 75204-8233
Phone (214) 219-6655

Hospital & facility affiliations

  • Baylor University Medical Center Hospital, Dallas, TX, CCN 450021
  • Baylor Scott & White Institute for Rehabilitation Inpatient rehabilitation facility, Dallas, TX, CCN 453036

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Mar 1, 2019 Accepting new patients
Healthtexas Provider Network Internal Medicine Current Accepting new patients
Healthtexas Provider Network CurrentSince Mar 1, 2019 Accepting new patients

Locations

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

301 N Washington Ave
Fl 5
Dallas, TX 75246
Phone (469) 800-8742

4161 McKinney Ave
Ste 300
Dallas, TX 75204
Phone (214) 219-6655

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

700 Walter Reed Blvd
Ste 203
Garland, TX 75042
Phone (972) 426-9900

1441 S Midlothian Pkwy
Ste 100A
Midlothian, TX 76065
Phone (469) 800-9440

1441 S Midlothian Pkwy
Ste 100
Midlothian, TX 76065
Phone (469) 800-9600

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

301 E Ovilla Rd
Ste 100
Red Oak, TX 75154
Phone (469) 800-9200

273 E Ovilla Rd
Ste 4
Red Oak, TX 75154
Phone (972) 617-5225

505 N Highway 77
Ste 200
Waxahachie, TX 75165
Phone (972) 923-1686

Interoperability endpoints

  • Direct secure messaging: jnordstrom224976@direct.sw.org

Organizations & group practices 3

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 2

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1023058815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4161 MCKINNEY AVE STE 300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752048233",
            "telephone_number": "972-817-7040",
            "fax_number": "972-817-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 MCKINNEY AVE STE 300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752048233",
            "telephone_number": "972-817-7040",
            "fax_number": "972-817-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDSTROM",
        "first_name": "JESSICA",
        "middle_name": "GRACE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L9399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1670515-02",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8J1473",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167051503",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8BR066",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnordstrom1351324@direct.sw.org",
            "affiliation": "N",
            "address_1": "4161 McKinney Ave Ste 300",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752048233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.