Individual provider Active NPI

Dakeya V Jordan, DO

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1124257431
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P4465 Issued in TX
Practice address
855 Montgomery St
Fort Worth, TX 76107-2553
Phone
(817) 735-2440
NPI assigned
Jul 8, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P4465 TX Primary

Addresses

Primary practice location

855 Montgomery St
Fort Worth, TX 76107-2553

Mailing address

PO Box 99335
Fort Worth, TX 76199-0335

Other identifiers 3

IdentifierTypeStateIssuer
8EL277OtherTXBCBS
337803601MedicaidTX
P01398102OtherTXRAILROAD 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
I20130430000621 TX Practitioner - Family Practice 1557508082 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network Family Medicine CurrentSince Feb 15, 2021 Accepting new patients
University of North Texas Health Science Center at Fort Worth Current Accepting new patients
Texas Oncology PA CurrentSince Feb 16, 2013 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients
University of North Texas Health Science Center at Fort Worth Current Accepting new patients
Texas Oncology PA CurrentSince Feb 16, 2013 Accepting new patients
Healthtexas Provider Network CurrentSince Feb 15, 2021 Accepting new patients
University of North Texas Health Science Center at Fort Worth Current Accepting new patients

Locations

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

7777 Forest Ln
Ste C707
Dallas, TX 75230
Phone (972) 566-3000

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

855 Montgomery St
Ft Worth, TX 76107
Phone (817) 735-2334

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

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

Interoperability endpoints

  • Direct secure messaging: djordan737111@direct.sw.org

Organizations & group practices 8

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": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1124257431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99335",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MONTGOMERY ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761072553",
            "telephone_number": "817-735-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "DAKEYA",
        "middle_name": "V",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EL277",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337803601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01398102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.