Organization Active NPI

Radius Medical

  • Internal Medicine Physician
  • Irving, TX
National Provider Identifier
1679378269
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
RADIUS MEDICAL
Practice address
4425 W Airport Fwy Ste 109
Irving, TX 75062-5810
Phone
(940) 882-0137
NPI assigned
Feb 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Authorized official

Name
Jessley Sara Ninan, LMSW
Title
Practice Manager
Phone
(940) 882-0137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

4425 W Airport Fwy Ste 109
Irving, TX 75062-5810

Mailing address

4425 W Airport Fwy Ste 109
Irving, TX 75062-5810
Phone (940) 882-0137

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250903000743 TX Part B Supplier - Clinic/Group Practice 9133620883 Receives reassigned benefits from 1 practitioner
Practice locations: Irving, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2331592Radius Medical4425 Airport Fwy 109, Irving, TX 75062Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory

Locations

4425 W Airport Fwy
Ste 109
Irving, TX 75062
Phone (281) 715-3430

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1739750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1679378269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 W AIRPORT FWY STE 109",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750625810",
            "telephone_number": "940-882-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 W AIRPORT FWY STE 109",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750625810",
            "telephone_number": "940-882-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIUS MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "NINAN",
        "authorized_official_first_name": "JESSLEY",
        "authorized_official_middle_name": "SARA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "940-882-0137",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.