NPIMap

Organization Active NPI

Dallas County Hospital District

Doing business as Southeast Dallas Acute Response Clinic

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1154780245
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DALLAS COUNTY HOSPITAL DISTRICT
Doing business as
Southeast Dallas Acute Response Clinic
Practice address
9202 Elam Rd FL 1
Dallas, TX 75217-4151
Phone
(214) 266-1834
NPI assigned
Feb 17, 2016
Last updated
Dec 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Authorized official

Name
Frederick P Cerise, MD
Title
President & Chief Executive Officer
Phone
(214) 590-8006

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Social Worker 104100000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

9202 Elam Rd FL 1
Dallas, TX 75217-4151

Mailing address

PO Box 660599
Dallas, TX 75266-0599

Other identifiers 1

IdentifierTypeStateIssuer
355956901MedicaidTX

Other names 1

  • Southeast Dallas Acute Response Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000583 TX Part B Supplier - Clinic/Group Practice 8325934813 Receives reassigned benefits from 932 practitioners
44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dallas, TX; Irving, TX; Grand Prairie, TX; Garland, TX; Farmers Branch, TX
O20060918000188 TX Part A Provider - Hospital 8325934813 44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154780245. Details of each certification follow.

Hospital certification: CCN 450015

Legal name
DALLAS COUNTY HOSPITAL DISTRICT
Doing business as
PARKLAND HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 14, 2024
Beds
968
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
5200 Harry Hines Blvd
Dallas, TX 75235-7709
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 49

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 49

Care Compare: Hospital

Medicare Care Compare
Listed as
Parkland Health & Hospital SystemCCN 450015 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Dallas Cnty Hospital Di94 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

9202 Elam Rd
#210
Dallas, TX 75217

9202 Elam Rd
Fl 1
Dallas, TX 75217
Phone (214) 266-1500

9202 Elam Rd
Ste 210
Dallas, TX 75217
Phone (214) 266-1834

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Frederick P Cerise Individual Corporate OfficerChief Executive Officer Mar 24, 2014 100%
Operational/Managerial ControlPresident Chief Executive Office Mar 24, 2014
Gerry Baker Individual Corporate DirectorSr VP Revenue Cycle Apr 29, 2021
W-2 Managing EmployeeSr VP Revenue Cycle Apr 29, 2021
Dallas County Hospital District Organization, Dallas, TX Corporation Operational/Managerial Control Apr 22, 1966
Errica Brown Individual W-2 Managing EmployeeProvider Enrollment Program Mana Oct 13, 2020

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

Affiliated clinicians 1,656

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,656

NPI Registry JSON

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1154780245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660599",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 ELAM RD FL 1",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752174151",
            "telephone_number": "214-266-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-17",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "CERISE",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-590-8006",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355956901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Dallas Acute Response Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.