Destination Health

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

H6268 Issued in TX

Legal business name

DESTINATION HEALTH

Practice address

900 E Southlake Blvd
Suite 200
Southlake, TX 76092-6375

Phone

(817) 310-6050

Fax

(817) 310-6051

NPI assigned

Nov 14, 2014

Last updated

Nov 14, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Julie K Timmons

Title

Operations Manager

Phone

(817) 310-6050

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Carl Edwin Ducharme, D.O.

  • Internal Medicine Physician
  • Southlake, TX
  • NPI 1154642999
  NPD (past)
• Robin Annette Hall, D.O.

  • Adult Medicine Physician
  • Southlake, TX
  • NPI 1285787085
  NPD (past)
• Christopher A Hughes, M.D.

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1255491858
  NPD (past)
• Jennifer Ruth Kessmann, MD

  • Adult Medicine Physician
  • Dallas, TX
  • NPI 1093897316
  NPD (past)
• Eric Paul Freitas, MD

  • Family Medicine Physician
  • Newington, CT
  • NPI 1033552815
  NPD (past)
• Rachel Ann Jensen, NP

  • Family Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1518443142
  NPD (past)

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

{
    "created_epoch": "1415923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1346646528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E SOUTHLAKE BLVD",
            "address_2": "SUITE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926375",
            "telephone_number": "817-310-6050",
            "fax_number": "817-310-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E SOUTHLAKE BLVD",
            "address_2": "SUITE 200",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926375",
            "telephone_number": "817-310-6050",
            "fax_number": "817-310-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINATION HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-14",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "TIMMONS",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "817-310-6050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "TX",
            "license": "H6268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis E. Minotti,II,D.O.,PLLC (North Texas Musculoskeletal Medicine)
• Jennifer Depetro, PH.D.
• Dermatology and Plastic Surgery Specialists PLLC (Plastic Surgery Specialists)
• Montanique Deshay
• Rachelle Dess, FNP
• Eric William Dettweiler, PT
• Devdas Psychological Services
• Neetha Devdas, PH.D.
• Sharmila Devidoss, M.D.
• Jordan Devine

• Adult Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Adult Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.