Active NPI
Maynard C Dyson, MD
- Pediatric Pulmonology Physician
- Fort Worth, TX
National Provider Identifier
1619988763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Pulmonology Physician
- License
- H9069
- Practice address
- 1500 Cooper St
Fort Worth, TX 76104-2710 - Phone
- (682) 885-6299
- Fax
- (682) 885-1090
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Pulmonology Physician | 2080P0214X | H9069 | TX | Primary |
Addresses
Primary practice location
1500 Cooper St
Fort Worth, TX 76104-2710
Mailing address
PO Box 99371
Fort Worth, TX 76199-0371
Phone (682) 885-1855
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1392667 | Other | TX | UHC PIN |
| 1485631 | Other | TX | CIGNA PIN |
| 136186712 | Medicaid | TX | |
| 140442845 | Medicaid | TX | |
| 1640370 | Other | TX | FIRSTHEALTH PIN |
| 136186714 | Medicaid | TX | |
| 136186715 | Other | TX | CSHCN |
| 4613484 | Other | TX | AETNA PIN |
| 62741133 | Other | TX | MULTIPLAN PIN |
| 00U87Z | Other | TX | BCBSTX GRP PIN |
| 112070100 | Other | TX | FIRSTCARE PIN |
| 136186713 | Other | TX | CSHCN |
| 386710 | Other | TX | GREAT WEST PIN |
| 413449 | Other | TX | PHCS PIN |
| 10028696 | Other | TX | AMERIGROUP PIN |
| 109539 | Other | TX | SUPERIOR PIN |
| 89V243 | Other | TX | BCBSTX IND PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook Children's Medical Center | Past | Accepting new patients |
Interoperability endpoints
- maynard.dyson@direct.myteamcare.com
Organizations & group practices 1
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.
-
dba Cook Children's Behavioral Health
- Clinical Child & Adolescent Psychologist
- Fort Worth, TX
- NPI 1942509963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1619988763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99371",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990371",
"telephone_number": "682-885-1855",
"fax_number": "682-885-7347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 COOPER ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761042710",
"telephone_number": "682-885-6299",
"fax_number": "682-885-1090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYSON",
"first_name": "MAYNARD",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0214X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Pulmonology",
"state": "TX",
"license": "H9069",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC PIN",
"identifier": "1392667",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PIN",
"identifier": "1485631",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136186712",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "140442845",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTHEALTH PIN",
"identifier": "1640370",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136186714",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "136186715",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN",
"identifier": "4613484",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN PIN",
"identifier": "62741133",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX GRP PIN",
"identifier": "00U87Z",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTCARE PIN",
"identifier": "112070100",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSHCN",
"identifier": "136186713",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT WEST PIN",
"identifier": "386710",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS PIN",
"identifier": "413449",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP PIN",
"identifier": "10028696",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR PIN",
"identifier": "109539",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX IND PIN",
"identifier": "89V243",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.