Individual provider Active NPI

Ralph J Deberardinis, MD PHD

  • Pediatrics Physician
  • Dallas, TX
National Provider Identifier
1043239692
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M9959 Issued in TX
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

Updated by the provider on Apr 15, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
195046101MedicaidTX
DE08K8816OtherTXTEXAS 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080707000608 TX Practitioner - Pediatric Medicine 3971528209 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD419592PAMDPediatrics Physician
M9959TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Oct 1, 2014 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas Pediatrics CurrentSince Oct 1, 2014 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.

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

Verify at the official NPI Registry.