Organization Active NPI

My Care on Demand LLC

  • Family Medicine Physician
  • Desoto, TX
National Provider Identifier
1255950002
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MY CARE ON DEMAND LLC
Practice address
2707 Bolton Boone Dr Ste 102
Desoto, TX 75115-2077
Phone
(469) 530-4990
NPI assigned
Apr 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
Mr. Damian Irabor, FNPNPI 1285003236
Title
Member
Phone
(214) 356-5165

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Primary Care Clinic/Center 261QP2300X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

2707 Bolton Boone Dr Ste 102
Desoto, TX 75115-2077

Mailing address

2707 Bolton Boone Dr Ste 102
Desoto, TX 75115-2077
Phone (469) 530-4990

Other names 1

  • MyCare Family and Wellness Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250331001353 TX Part B Supplier - Clinic/Group Practice 2365965308 Receives reassigned benefits from 1 practitioner
Practice locations: Desoto, TX

National Provider Directory

National Provider Directory

Locations

2707 Bolton Boone Dr
Ste 102
Desoto, TX 75115
Phone (468) 530-4990

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1586649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1255950002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 BOLTON BOONE DR STE 102",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152077",
            "telephone_number": "469-530-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 BOLTON BOONE DR STE 102",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152077",
            "telephone_number": "469-530-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY CARE ON DEMAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-12",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "IRABOR",
        "authorized_official_first_name": "DAMIAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "214-356-5165",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyCare Family and Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.