Active NPI
NTKC-DFW, PLLC
- Nephrology Physician
- Bedford, TX
National Provider Identifier
1386979649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209283502 | Medicaid | TX |
Other names 1
- North Texas Kidney Consultants
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1087602 | North Texas Kidney Consultants-DFW | Certificate of waiver | Aug 6, 2026 |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Nephrology Physician
- Arlington, TX
- NPI 1902840853
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.