Individual provider Active NPI

Matthew Ryan Weissenborn, M.D.

  • Diagnostic Radiology Physician
  • Addison, TX
National Provider Identifier
1639513641
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
Q4333 Issued in TX
Practice address
4450 Sojourn Dr Ste 200
Addison, TX 75001-5000
Phone
(972) 733-0014
Fax
(972) 733-0125
NPI assigned
Apr 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X Q4333 TX
Diagnostic Radiology Physician 2085R0202X Q4333 TX Primary

Addresses

Primary practice location

4450 Sojourn Dr Ste 200
Addison, TX 75001-5000

Mailing address

PO Box 678253
Dallas, TX 75267-8253
Phone (800) 841-4236

Other identifiers 1

IdentifierTypeStateIssuer
398449405MedicaidTX

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
I20190618002778 TX Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 9133453533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Texas Tech University Health Science Center School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3500 Gaston Ave
Dallas, TX 75246-2017
Phone (214) 820-3216

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.26 of 100Reported as group
Quality
100
Improvement activities
40
Cost
72.03

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q4333TXMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Btdi JV LLP CurrentSince Jul 1, 2019 Accepting new patients
Btdi JV LLP CurrentSince Sep 30, 2023 Accepting new patients
Btdi JV LLP CurrentSince Jan 1, 2023 Accepting new patients
Blue Stone JV LLP CurrentSince Oct 1, 2024 Accepting new patients
Btdi JV LLP CurrentSince Nov 25, 2021 Accepting new patients
Btdi JV, LLP CurrentSince Nov 1, 2023 Accepting new patients
Btdi JV LLP CurrentSince Jul 2, 2019 Accepting new patients
Btdi JV LLP CurrentSince Oct 1, 2023 Accepting new patients
Btdi JV, LLP CurrentSince Jul 1, 2019 Accepting new patients
Btdi JV LLP CurrentSince Jul 3, 2019 Accepting new patients
Btdi JV, LLP CurrentSince Aug 18, 2021 Accepting new patients
Btdi JV LLP CurrentSince Nov 25, 2021 Accepting new patients
American Radiology Consultants PLLC Diagnostic Radiology CurrentSince Jul 1, 2019 Accepting new patients
Btdi JV LLP CurrentSince Jul 3, 2019 Accepting new patients
Btdi JV LLP CurrentSince Jul 1, 2019 Accepting new patients
Btdi JV LLP CurrentSince Jan 1, 2023 Accepting new patients

Locations (25 of 28)

4450 Sojourn Dr
Ste 200
Addison, TX 75001
Phone (469) 850-5760

1612 Hospital Pkwy
Bedford, TX 76022
Phone (817) 685-4700

7777 Forest Ln
Ste D100
Dallas, TX 75230

712 N Washington Ave
Ste 102
Dallas, TX 75246
Phone (214) 515-0016

2727 E Lemmon Ave
Dallas, TX 75204
Phone (214) 443-3000

621 N Hall St
Dallas, TX 75226
Phone (214) 820-0600

3500 Gaston Ave
Dallas, TX 75246

9109 N Central Expy
Ste 100
Dallas, TX 75231

9301 N Central Expy
Ste 200
Dallas, TX 75231
Phone (214) 389-9130

7777 Forest Ln
Ste C707
Dallas, TX 75230
Phone (972) 566-3000

712 N Washington Ave
Dallas, TX 75246
Phone (214) 580-3630

3900 Junius St
Ste 200
Dallas, TX 75246
Phone (214) 820-2430

6301 Gaston Ave
Ste 180
Dallas, TX 75214
Phone (214) 826-6700

3900 Junius St
Ste 100
Dallas, TX 75246
Phone (214) 820-6900

1441 W Jefferson Blvd
Dallas, TX 75208

1901 Grandview Ave
El Paso, TX 79902
Phone (915) 544-6750

1450 8th Ave
Ft Worth, TX 76104
Phone (817) 702-8300

4501 Joe Ramsey Blvd E
Ste 120
Greenville, TX 75401
Phone (903) 201-6688

2021 N MacArthur Blvd
Ste 400
Irving, TX 75061
Phone (972) 253-3751

1300 N 4th St
Longview, TX 75601
Phone (903) 757-2122

1202 W Frank Ave
Lufkin, TX 75904
Phone (639) 637-6415

4510 Medical Center Dr
Ste 215
McKinney, TX 75069
Phone (469) 952-5007

3705 W 15th St
Plano, TX 75075
Phone (972) 867-3577

1350 First Colony Blvd
Sugar Land, TX 77479
Phone (281) 276-3467

2400 N Interstate Highway 35 E
Waxahachie, TX 75165
Phone (469) 843-4000

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1366502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1639513641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678253",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678253",
            "telephone_number": "800-841-4236",
            "fax_number": "706-653-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 SOJOURN DR STE 200",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750015000",
            "telephone_number": "972-733-0014",
            "fax_number": "972-733-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISSENBORN",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-21",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "TX",
            "license": "Q4333",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "Q4333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398449405",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, TX

Sources for this page

Verify at the official NPI Registry.