Individual provider Active NPI

Emily Katherine Jensen, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1669259297
Registry record updated Feb 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17661 Issued in TX
Practice address
816 W Cannon St
Fort Worth, TX 76104-3194
Phone
(817) 321-0499
NPI assigned
Sep 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA17661 TX Primary

Addresses

Primary practice location

816 W Cannon St
Fort Worth, TX 76104-3194

Mailing address

4001 Ross Ave Apt 265
Dallas, TX 75204-5268
Phone (512) 923-8654

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
I20240426000262 TX Practitioner - Physician Assistant 2264872035 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Clinical Care in RadiologyGroup PAC ID 8729429592, 15 clinicians

Practice addresses (Care Compare)

1301 Pennsylvania Ave
Fort Worth, TX 76104-2122
Phone (817) 321-0937

1400 8TH Ave
Fort Worth, TX 76104-4110
Phone (817) 926-2544

1500 S Main St
Fort Worth, TX 76104-4917
Phone (817) 321-0937

1622 8TH Ave
Suite 120
Fort Worth, TX 76104-4155
Phone (817) 934-5499

1650 W College St
Grapevine, TX 76051-3565
Phone (817) 321-0404

17980 Dallas Pkwy
Suite 200
Dallas, TX 75287-6817
Phone (817) 321-0937

800 W Magnolia Ave
Fort Worth, TX 76104-4611

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA17661TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates of North Texas PA CurrentSince May 20, 2024 Accepting new patients
Radiology Associates of North Texas PA CurrentSince May 20, 2024 Accepting new patients

Locations

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

1622 8th Ave
Ste 120
Fort Worth, TX 76104
Phone (817) 923-8220

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

1814 Roseland Blvd
Ste 100
Tyler, TX 75701
Phone (214) 696-8033

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": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1669259297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 ROSS AVE APT 265",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752045268",
            "telephone_number": "512-923-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043194",
            "telephone_number": "817-321-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "EMILY",
        "middle_name": "KATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-08",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA17661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.