Active NPI
Ralph J Deberardinis, MD PHD
- Pediatrics Physician
- Dallas, TX
National Provider Identifier
1043239692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M9959
- Practice address
- 5323 Harry Hines Blvd
Dallas, TX 75390-7201 - Phone
- (214) 633-1803
- Fax
- (214) 648-5515
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Genetics (M.D.) Physician | 207SG0201X | MD419592 | PA | |
| Clinical Biochemical Genetics Physician | 207SG0202X | MD419592 | PA | |
| Ph.D. Medical Genetics Physician | 207SG0205X | MD419592 | PA | |
| Pediatrics Physician | 208000000X | MD419592 | PA | |
| Pediatrics Physician | 208000000X | M9959 | TX | Primary |
Addresses
Primary practice location
5323 Harry Hines Blvd
Dallas, TX 75390-7201
Mailing address
PO Box 845347
Dallas, TX 75284-5347
Phone (214) 633-1803
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 195046101 | Medicaid | TX | |
| DE08K8816 | Other | TX | TEXAS MEDICARE |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD419592 | PA | MD | Pediatrics Physician |
| M9959 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The University of Texas Southwestern Medical Center at Dallas | Current | Accepting new patients | |
| University of Texas Southwestern Medical Center at Dallas | Current | Accepting new patients | |
| University of Texas Southwestern Medical Center at Dallas | Pediatrics | Current | Accepting new patients |
Locations
2222 Welborn St
Dallas, TX 75219
Phone (214) 559-5000
420 E 6th St
Ste 202
Odessa, TX 79761
Phone (214) 648-9618
5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365984000000",
"number": "1043239692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 845347",
"city": "DALLAS",
"state": "TX",
"postal_code": "752845347",
"telephone_number": "214-633-1803",
"fax_number": "214-648-5515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5323 HARRY HINES BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "753907201",
"telephone_number": "214-633-1803",
"fax_number": "214-648-5515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBERARDINIS",
"first_name": "RALPH",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2013-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "207SG0201X",
"taxonomy_group": "",
"desc": "Medical Genetics, Clinical Genetics (M.D.)",
"state": "PA",
"license": "MD419592",
"primary": false
},
{
"code": "207SG0202X",
"taxonomy_group": "",
"desc": "Medical Genetics, Clinical Biochemical Genetics",
"state": "PA",
"license": "MD419592",
"primary": false
},
{
"code": "207SG0205X",
"taxonomy_group": "",
"desc": "Medical Genetics, Ph.D. Medical Genetics",
"state": "PA",
"license": "MD419592",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD419592",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "M9959",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "195046101",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS MEDICARE",
"identifier": "DE08K8816",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.