Individual provider Active NPI

Jennifer Ruth Kessmann, MD

  • Adult Medicine Physician
  • Dallas, TX
National Provider Identifier
1093897316
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
J6521 Issued in TX
Practice address
12240 Inwood Rd Ste 500
Dallas, TX 75244-8007
Phone
(817) 912-1289
NPI assigned
Oct 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X J6521 TX Primary

Addresses

Primary practice location

12240 Inwood Rd Ste 500
Dallas, TX 75244-8007

Mailing address

PO Box 96163
Southlake, TX 76092-0126
Phone (817) 912-1289

Other practice location 1

9003 Airport Fwy
Suite 300
North Richland Hills, TX 76180-7770
Phone (817) 514-5200

Other practice location 2

521 W Southlake Blvd Ste 100
Southlake, TX 76092-6173
Phone (817) 912-1289

Other identifiers 1

IdentifierTypeStateIssuer
133214007MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6521TXMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Destination Health Adult Medicine Past Accepting new patients
Acs Primary Care Physicians Southwest, PA Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jennifer.kessmann@hca7.eclinicaldirectplus.com

Organizations & group practices 2

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1093897316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96163",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760920126",
            "telephone_number": "817-912-1289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12240 INWOOD RD STE 500",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752448007",
            "telephone_number": "817-912-1289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9003 Airport Fwy",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "North Richland Hills",
            "state": "TX",
            "postal_code": "761807770",
            "country_code": "US",
            "telephone_number": "817-514-5200",
            "fax_number": "817-514-5210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "521 W Southlake Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760926173",
            "country_code": "US",
            "telephone_number": "817-912-1289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KESSMANN",
        "first_name": "JENNIFER",
        "middle_name": "RUTH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "J6521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133214007",
            "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 Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.