Delta Medical PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

K9263 Issued in TX

Legal business name

DELTA MEDICAL PA

Doing business as

Delta Medical Clinic

Practice address

12001 South Fwy
Suite 210
Burleson, TX 76028-7208

Phone

(817) 293-8797

NPI assigned

May 31, 2006

Organization subpart

No

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

Authorized official

Name

Kofoworola Ekadi, M.D.NPI 1942262316

Title

President

Phone

(817) 412-8769

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• DELTA MEDICAL CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HEDJCD

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kofoworola Ekadi, M.D.

  • Internal Medicine Physician
  • Burleson, TX
  • NPI 1942262316
  Medicare reassignment NPD Authorized official
• Sarah Ann Mitchell, FNP-BC

  • Family Nurse Practitioner
  • Burleson, TX
  • NPI 1134637820
  Medicare reassignment NPD
• Steven Leon Gates, D.O.

  • Geriatric Medicine (Internal Medicine) Physician
  • Conroe, TX
  • NPI 1184602443
  NPD (past)

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680912000000",
    "number": "1073550919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93869",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760920118",
            "telephone_number": "817-293-8797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12001 SOUTH FWY",
            "address_2": "SUITE 210",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760287208",
            "telephone_number": "817-293-8797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2023-04-08",
        "certification_date": "2023-04-08",
        "status": "A",
        "authorized_official_last_name": "EKADI",
        "authorized_official_first_name": "KOFOWOROLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-412-8769",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K9263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "00W561",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00053593",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DELTA MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dennis M Dean, O.D.
• Heather Suzanne Dean, AU.D.
• Debra Tahmahkera
• Ryan Alan Deleon, D.C.
• Noelia Delgado Rosas, PA-C
• Lou Ellen Demott, L.M.T.
• Juoyu Deng, M.A., LPC.
• Cari Michele Denham, M.A., LMFT
• Dennis M Dean
• Bailey Dent

• Internal Medicine Physician in Burleson, TX
• Providers in Burleson, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.