Jeffrey Jessada Lertdilok, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP142915 Issued in TX

Practice address

4100 Fairway Dr Ste 320
Carrollton, TX 75010-6537

Phone

(972) 236-7608

NPI assigned

Oct 18, 2019

Last updated

Oct 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Infusions LLCGroup PAC ID 6608054044, 102 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovative Infusions, LLC

  dba Paragon Infusion Centers

  • Infusion Therapy Clinic/Center
  • Dallas, TX
  • NPI 1811299944
  Medicare reassignment Care Compare group NPD
• Fairway Family Medicine-Primary Care, PLLC

  • Primary Care Clinic/Center
  • Carrollton, TX
  • NPI 1508115718
  NPD
• Innovative Infusions, LLC

  dba Paragon Infusion Centers

  • Infusion Therapy Clinic/Center
  • Indianapolis, IN
  • NPI 1093512246
  NPD

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1720621071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 CATAWBA AVE",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750101196",
            "telephone_number": "972-746-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 FAIRWAY DR STE 320",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106537",
            "telephone_number": "972-236-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERTDILOK",
        "first_name": "JEFFREY",
        "middle_name": "JESSADA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-18",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP142915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Legent Physicians Network
• Marla J Lehmann, PA
• Ronald John Lehrer I, D.C.
• Cora Teresa Lemens, PA
• Lenae White, M.D. P.a.
• Michael Jeremy Leslie, BCABA
• Marygrace C Leveille, NP
• Taylor Lewis
• Mindy Li, DDS
• Andrea Libby, PTA

• Family Nurse Practitioner in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.