Individual provider Active NPI

Kenneth Basil Godsey, M.D.

  • Internal Medicine Physician
  • Plano, TX
National Provider Identifier
1649384116
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H1774 Issued in TX
Practice address
4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339
Phone
(972) 758-6000
Fax
(972) 758-6001
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H1774 TX Primary

Addresses

Primary practice location

4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339

Mailing address

4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339
Phone (972) 758-6000

Other identifiers 2

IdentifierTypeStateIssuer
0980039-03MedicaidTX
010054856OtherTXRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgodsey222475@direct.sw.org

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
I20040802000531 TX Practitioner - Internal Medicine 3779554118 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network Internal Medicine Current Accepting new patients
Healthtexas-Dallas Diagnostic Association Internal Medicine CurrentSince Nov 1, 2004 Accepting new patients
Healthtexas Provider Network CurrentSince Jun 3, 2019 Accepting new patients
Healthtexas Provider Network CurrentSince Jun 3, 2019 Accepting new patients
Healthtexas Provider Network--Dallas Diagnostic Association Internal Medicine CurrentSince Nov 1, 2004 Accepting new patients

Locations

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (972) 860-8648

4708 Alliance Blvd
Ste 300
Plano, TX 75093
Phone (972) 758-6000

4700 Alliance Blvd
Ste 400
Plano, TX 75093
Phone (469) 814-6631

4716 Alliance Blvd
Ste 500
Plano, TX 75093

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1649384116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 ALLIANCE BLVD STE 300",
            "address_2": "BAYLOR MEDICAL PLAZA 1",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935339",
            "telephone_number": "972-758-6000",
            "fax_number": "972-758-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4708 ALLIANCE BLVD STE 300",
            "address_2": "BAYLOR MEDICAL PLAZA 1",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935339",
            "telephone_number": "972-758-6000",
            "fax_number": "972-758-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODSEY",
        "first_name": "KENNETH",
        "middle_name": "BASIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H1774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0980039-03",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "010054856",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgodsey222475@direct.sw.org",
            "affiliation": "N",
            "address_1": "4716 Alliance Blvd Ste 500",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750935386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.