Individual provider Active NPI

Anna Tavakkoli, M.D.

  • Gastroenterology Physician
  • Dallas, TX
National Provider Identifier
1568752756
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
R7610 Issued in TX
Practice address
5959 Harry Hines Blvd
Dallas, TX 75390-5362
Phone
(469) 291-3372
NPI assigned
Apr 9, 2011
Last updated
Jun 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 4301104725 MI
Gastroenterology Physician 207RG0100X 4301104725 MI
Gastroenterology Physician 207RG0100X R7610 TX Primary

Addresses

Primary practice location

5959 Harry Hines Blvd
Dallas, TX 75390-5362

Mailing address

PO Box 845347
Dallas, TX 75284-7208

Other practice location 1

1500 E Medical Center Dr
3rd floor Taubman Center Recp D
Ann Arbor, MI 48109-5362
Phone (734) 647-5944

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
I20181009002829 TX Practitioner - GastroenterologyPractitioner - Internal Medicine 8628378536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1801 Inwood Rd
FL 1
Dallas, TX 75235-7202
Phone (214) 645-3300

Hospital & facility affiliations

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux163

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301104725MIMDGastroenterology Physician
R7610TXMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Nov 10, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Internal Medicine CurrentSince Nov 10, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients

Locations

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

5959 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 645-0595

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

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: atavakkoli156167@direct.swmed.us

Organizations & group practices 3

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 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": "1302307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1568752756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753905362",
            "telephone_number": "469-291-3372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Dr",
            "address_2": "3rd floor Taubman Center Recp D",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095362",
            "country_code": "US",
            "telephone_number": "734-647-5944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAVAKKOLI",
        "first_name": "ANNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-09",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301104725",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301104725",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TX",
            "license": "R7610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.