Individual provider Active NPI

Dima Otaishan

  • Hospitalist Physician
  • Dallas, TX
National Provider Identifier
1417451618
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
U9327 Issued in TX
Practice address
6201 Harry Hines Blvd
Dallas, TX 75390-8409
Phone
(817) 987-3955
NPI assigned
Mar 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X U9327 TX Primary
Hospitalist Physician 208M00000X 036156979 IL
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

6201 Harry Hines Blvd
Dallas, TX 75390-8409

Mailing address

P.O. Box 845347
Dallas, TX 75284

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240531003575 TX Practitioner - HospitalistPractitioner - Internal Medicine 5890039895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

6201 Harry Hines Blvd
Dallas, TX 75390-9032
Phone (214) 633-5555

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

Merit-based Incentive Payment System (MIPS)

Final score
53.64 of 100Reported as group
Quality
20.75
Promoting interoperability
100
Improvement activities
0
Cost
74.72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036156979ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 24, 2024 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 24, 2024 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients

Locations

6201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 633-4700

5151 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-3000

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

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 1

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": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1417451618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753908409",
            "telephone_number": "817-987-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTAISHAN",
        "first_name": "DIMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "U9327",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036156979",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.