Individual provider Active NPI

Jeremiah Ross, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1669068581
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1006757 Issued in TX
Practice address
3500 Gaston Ave
Dallas, TX 75246-2017
Phone
(214) 820-0111
NPI assigned
Dec 15, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1006757 TX Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1006757 TX

Addresses

Primary practice location

3500 Gaston Ave
Dallas, TX 75246-2017

Mailing address

4835 LBJ Fwy Ste 900
Dallas, TX 75244-6001
Phone (469) 420-5505

Other practice location 1

1508 Spenwick Ter
Dallas, TX 75204-5531
Phone (512) 460-0453

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210414000656 TX Practitioner - Nurse Practitioner 9436567344 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Surgery Associates PAGroup PAC ID 0042122137, 58 clinicians
North Texas Critical Care PAGroup PAC ID 6103041637, 79 clinicians

Practice addresses (Care Compare)

1400 8TH Ave
Fort Worth, TX 76104-4110
Phone (214) 821-1599

2710 Swiss Ave
Dallas, TX 75204-5900
Phone (214) 821-2303

3500 Gaston Ave
Dallas, TX 75246-2017
Phone (214) 820-0111

621 N Hall St
Dallas, TX 75226-1339
Phone (214) 820-0600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.87 of 100Reported as group
Quality
90.89
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.41 of 100Reported as group
Quality
88.72
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1006757TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Soka Psychiatry and Wellness Company PC Psychiatric/Mental Health CurrentSince Aug 26, 2025 Accepting new patients
Urgent Surgery Associates, P.a. CurrentSince Jan 8, 2022 Accepting new patients
North Texas Critical Care PA CurrentSince Mar 1, 2021 Accepting new patients

Locations

3500 Gaston Ave
Dallas, TX 75246

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

2710 Swiss Ave
Dallas, TX 75204
Phone (214) 821-2303

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1669068581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 LBJ FWY STE 900",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752446001",
            "telephone_number": "469-420-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 GASTON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752462017",
            "telephone_number": "214-820-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1508 Spenwick Ter",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752045531",
            "country_code": "US",
            "telephone_number": "512-460-0453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS",
        "first_name": "JEREMIAH",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-15",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1006757",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1006757",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.