NPIMap

Organization Active NPI

Medconmd1 PLLC

  • Emergency Medicine Physician
  • Dallas, TX
National Provider Identifier
1649028267
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MEDCONMD1 PLLC
Practice address
7502 Greenville Ave
Dallas, TX 75231-3802
Phone
(844) 391-7277
Fax
(512) 857-1634
NPI assigned
May 8, 2024
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Jason Kyle Hooper
Title
Executive Vice President
Phone
(817) 291-7405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

7502 Greenville Ave
Dallas, TX 75231-3802

Mailing address

PO Box 935
Forney, TX 75126-0935
Phone (844) 391-7277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240816003368 TX Part B Supplier - Clinic/Group Practice 2466739776 Receives reassigned benefits from 3 practitioners
Practice locations: Dallas, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Medconmd12 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

505 E US Highway 80
Forney, TX 75126
Phone (844) 391-7277

2508 Williams Dr
Ste 120
Georgetown, TX 78628
Phone (844) 391-7277

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1649028267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 935",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751260935",
            "telephone_number": "844-391-7277",
            "fax_number": "512-857-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7502 GREENVILLE AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752313802",
            "telephone_number": "844-391-7277",
            "fax_number": "512-857-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCONMD1 PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "HOOPER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "817-291-7405"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.