Katrina Jean Tidwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03458 Issued in TX

Practice address

8196 Walnut Hill LN
Ste 100
Dallas, TX 75231-4452

Phone

(214) 739-4175

Fax

(214) 346-3516

NPI assigned

Jun 16, 2009

Sex

Female

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

Physician Assistant

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Oncology PAGroup PAC ID 5395658934, 1,001 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Presbyterian Hospital Dallas Hospital, Dallas, TX, CCN 450462

Merit-based Incentive Payment System (MIPS)

Final score

85.12 of 100Reported as apm

Quality

67.48

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katrina.tidwell@txo.ikm.direct-ci.com

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.

• Texas Oncology PA

  • Medical Oncology Physician
  • El Paso, TX
  • NPI 1811944101
  Medicare reassignment Care Compare group NPD (past)
• Texas Oncology PA

  • Medical Oncology Physician
  • Fort Worth, TX
  • NPI 1033386578
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Texas Health Presbyterian Hospital Dallas

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1396779948
  Care Compare affiliation

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440720000000",
    "number": "1790912806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8196 WALNUT HILL LN",
            "address_2": "STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314452",
            "telephone_number": "214-739-4175",
            "fax_number": "214-346-3516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8196 WALNUT HILL LN",
            "address_2": "STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314452",
            "telephone_number": "214-739-4175",
            "fax_number": "214-346-3516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "KATRINA",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-16",
        "last_updated": "2015-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Tice, MD
• Tich Ngoc Truong MD PA
• Willibroad W Ticha, PHD
• Joshua Monroe Tidman, MD
• Jerithea Doronice Tidwell, RN PHD, PNP, PCNS
• Tiffany Tidwell
• Laura Tiehen
• Emily Anne Tielleman, PA-C
• Thomas Tielleman, M.D.
• Tier 1 Medical Devices PLLC

• Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; 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.