John David Deetjen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1201 Fairmount Ave
Fort Worth, TX 76104-4215

Phone

(817) 335-5288

Fax

(817) 338-0927

NPI assigned

May 9, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Pulmonary and Critical Care Consultants PAGroup PAC ID 0840198818, 57 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
• Texas Health Harris Methodist Hospital Southwest F Hospital, Fort Worth, TX, CCN 450779
• Texas Health Heart & Vascular Hospital Arlington Hospital, Arlington, TX, CCN 670071
• Texas Health Arlington Memorial Hospital Hospital, Arlington, TX, CCN 450064
• Medical City Arlington Hospital, Arlington, TX, CCN 450675

Merit-based Incentive Payment System (MIPS)

Final score

92.25 of 100Reported as group

Promoting interoperability

85

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Texas Pulmonary & Critical Care Consultants, PA

  • Pulmonary Disease Physician
  • Fort Worth, TX
  • NPI 1427127968
  Medicare reassignment Care Compare group
• Texas Pulmonary & Critical Care Consultants, PA

  • Pulmonary Disease Physician
  • Dallas, TX
  • NPI 1871004473
  NPD (past)

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

• Amh Cath Labs LLC

  • Special Hospital
  • Arlington, TX
  • NPI 1407169196
  Care Compare affiliation
• Columbia Medical Center of Arlington Subsidiary LP

  • General Acute Care Hospital
  • Arlington, TX
  • NPI 1134172406
  Care Compare affiliation
• Texas Health Arlington Memorial Hospital

  • General Acute Care Hospital
  • Arlington, TX
  • NPI 1174533343
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation
• Texas Health Harris Methodist Hospital Southwest Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1417980202
  Care Compare affiliation

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1508556028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 HARRIS PKWY STE 285",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324127",
            "telephone_number": "817-263-5864",
            "fax_number": "817-394-6294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 FAIRMOUNT AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044215",
            "telephone_number": "817-335-5288",
            "fax_number": "817-338-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEETJEN",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Deen, MS, LPC
• Deepthi Parvataneni MD PA
• Susan Deering, ACNP
• Haley Lauren Dees
• Madison Danielle Dees
• Elizabeth Degrand, OTD, OTR
• Charis Degrate
• Dehaven Diagnostics, LLC
• Benjamin Michael Deheshi, MD
• Jonathan S. Deitch, M.D.

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.