NPIMap

Individual provider Active NPI

Daniela Gamboa Sejas, MD

  • Family Medicine Physician
  • Irving, TX
National Provider Identifier
1417141912
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N8188 Issued in TX
Practice address
1173 W John Carpenter Freeway
Suite 102
Irving, TX 75039
Phone
(469) 947-6020
Fax
(469) 947-6021
NPI assigned
Aug 29, 2007
Last updated
Feb 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N8188 TX Primary

Addresses

Primary practice location

1173 W John Carpenter Freeway
Suite 102
Irving, TX 75039

Mailing address

6828 Deleon St
Irving, TX 75039-3437
Phone (703) 725-7950

Other identifiers 6

IdentifierTypeStateIssuer
200302930 AMedicaidOK
P01217236OtherTXRAILROAD MEDICARE
63127881MedicaidNM
217849301MedicaidTX
217849303MedicaidTX
8DS368OtherTXBCBS

Other names 1

  • Daniela Gamboa Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207000758 TX Practitioner - Family Practice 4587851266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5920 Forest Park Rd
Dallas, TX 75235-6411
Phone (214) 266-0312

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N8188TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gamboa PLLC Family Medicine CurrentSince Feb 2, 2021 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 1, 2020 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Family Medicine CurrentSince Apr 1, 2020 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients

Locations

5920 Forest Park Rd
Dallas, TX 75235
Phone (214) 266-0312

1173 W John Carpenter Fwy
Ste 102
Irving, TX 75039
Phone (469) 947-6020

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: daniela.gamboa@iaaadp.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CBBDCD/Endpoint/CBBDCD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 44

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1417141912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6828 DELEON ST",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750393437",
            "telephone_number": "703-725-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 W JOHN CARPENTER FREEWAY",
            "address_2": "SUITE 102",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "75039",
            "telephone_number": "469-947-6020",
            "fax_number": "469-947-6021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOA SEJAS",
        "first_name": "DANIELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-29",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N8188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200302930 A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01217236",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "63127881",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217849301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217849303",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DS368",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELA",
            "last_name": "GAMBOA",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Irving, TX

Sources for this page

Verify at the official NPI Registry.