Individual provider Active NPI

Derek Kiser, PA-C

  • Physician Assistant
  • Plano, TX
National Provider Identifier
1396498507
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15279 Issued in TX
Practice address
4716 Alliance Blvd Ste 600
Plano, TX 75093-5378
Phone
(214) 820-6358
NPI assigned
Jan 27, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X PA15279 TX
Physician Assistant 363A00000X PA15279 TX Primary

Addresses

Primary practice location

4716 Alliance Blvd Ste 600
Plano, TX 75093-5378

Mailing address

825 Carver St
Mesquite, TX 75149-5011
Phone (830) 637-9849

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL n/a Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220411001487 TX Practitioner - Physician Assistant 7719373232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

4001 Worth St
Dallas, TX 75246-1608

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

4700 Alliance Blvd
Plano, TX 75093-5323

4716 Alliance Blvd
Suite 600
Plano, TX 75093-5378
Phone (469) 800-7200

821 N Coleman St
Suite 100
Prosper, TX 75078-2339
Phone (469) 800-5200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA15279TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Apr 11, 2022 Accepting new patients
Healthtexas Provider Network CurrentSince Apr 11, 2022 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

4716 Alliance Blvd
Ste 600
Plano, TX 75093
Phone (214) 820-6358

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Interoperability endpoints

  • Direct secure messaging: dkiser930934@direct.sw.org

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 and National Provider Directory roles.

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": "1643241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1396498507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 CARVER ST",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751495011",
            "telephone_number": "830-637-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4716 ALLIANCE BLVD STE 600",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935378",
            "telephone_number": "214-820-6358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISER",
        "first_name": "DEREK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-27",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "TX",
            "license": "PA15279",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA15279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "n/a",
            "affiliation": "N",
            "endpointDescription": "n/a",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4716 Alliance Blvd Ste 600",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750935378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.