NPIMap

Individual provider Active NPI

John Kyle Dorman, MD

  • Neurological Surgery Physician
  • Odessa, TX
National Provider Identifier
1215030333
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
L4342 Issued in TX
Practice address
540 W 5TH St Ste 320
Odessa, TX 79761-5002
Phone
(432) 580-4700
Fax
(432) 332-2678
NPI assigned
Sep 6, 2006
Last updated
Mar 25, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X L4342 TX Primary

Addresses

Primary practice location

540 W 5TH St Ste 320
Odessa, TX 79761-5002

Mailing address

540 W 5TH St Ste 320
Odessa, TX 79761-5002
Phone (432) 580-4700

Other identifiers 5

IdentifierTypeStateIssuer
8AJ418OtherTXBLUE CROSS BLUE SHIELD INDIVIDUAL NUMBER
166114201MedicaidTX
165059001MedicaidTX
L4342OtherTXPHYSICIAN LICENSE
0004QFOtherTXBCBS GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040622000148 TX Practitioner - Neurosurgery 4789669029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Texas Medical Branch at Galveston, 1994
Medicare assignment
May accept Medicare assignment
Group practices
Dora Roberts Rehabilitation CenterGroup PAC ID 0941285498, 114 clinicians
West Texas Neurosurgery PAGroup PAC ID 6709861040, 2 clinicians

Practice addresses (Care Compare)

306 W 3Rd St
Big Spring, TX 79720-2429
Phone (432) 267-3806

8050 E Hwy 191 212
Odessa, TX 79765-8615
Phone (432) 580-4700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion110
Laminectomy or laminotomy (partial removal of spine bones)40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Texas Neurosurgical Associates PA Neurological Surgery CurrentSince Jul 24, 2022 Accepting new patients
East Texas Minimally Inva Micro NS Neurological Surgery Past Accepting new patients

Locations

8050 E Highway 191
Ste 212
Odessa, TX 79765
Phone (432) 580-4700

Interoperability endpoints

  • Direct secure messaging: john.dorman.1@18076.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1215030333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 W 5TH ST STE 320",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615002",
            "telephone_number": "432-580-4700",
            "fax_number": "432-332-2678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 W 5TH ST STE 320",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615002",
            "telephone_number": "432-580-4700",
            "fax_number": "432-332-2678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMAN",
        "first_name": "JOHN",
        "middle_name": "KYLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "L4342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD INDIVIDUAL NUMBER",
            "identifier": "8AJ418",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166114201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165059001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN LICENSE",
            "identifier": "L4342",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0004QF",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.