Organization Active NPI

NTKC-DFW, PLLC

  • Nephrology Physician
  • Bedford, TX
National Provider Identifier
1386979649
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
NTKC-DFW, PLLC
Practice address
2425 Highway 121 Ste 201
Bedford, TX 76021-5083
Phone
(817) 283-5166
Fax
(817) 283-5176
NPI assigned
Oct 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Authorized official

Name
Dan Baccus
Title
Cfo
Phone
(817) 488-6669

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

2425 Highway 121 Ste 201
Bedford, TX 76021-5083

Mailing address

3801 William D Tate Ave Ste 105
Grapevine, TX 76051-8755
Phone (817) 488-6812

Other identifiers 1

IdentifierTypeStateIssuer
209283502MedicaidTX

Other names 1

  • North Texas Kidney Consultants Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1087602North Texas Kidney Consultants-DFW2425 Highway 121, Suite 201, Bedford, TX 76021Certificate of waiverAug 6, 2026

National Provider Directory

National Provider Directory

Locations

4907 S Collins St
Ste 101
Arlington, TX 76018
Phone (817) 375-0610

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": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783900800000",
    "number": "1386979649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WILLIAM D TATE AVE STE 105",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518755",
            "telephone_number": "817-488-6812",
            "fax_number": "817-251-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 HIGHWAY 121 STE 201",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760215083",
            "telephone_number": "817-283-5166",
            "fax_number": "817-283-5176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NTKC-DFW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-05",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A",
        "authorized_official_last_name": "BACCUS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "817-488-6669"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209283502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Texas Kidney Consultants",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Texas Kidney Consultants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bedford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.