Individual provider Active NPI

Maryam Ehtsham, MD

  • Internal Medicine Physician
  • Dallas, TX
National Provider Identifier
1831543842
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
S3511 Issued in TX
Practice address
1441 N Beckley Ave
Dallas, TX 75203-1201
Phone
(214) 947-2385
Fax
(214) 947-2390
NPI assigned
Apr 15, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X S3511 TX Primary

Addresses

Primary practice location

1441 N Beckley Ave
Dallas, TX 75203-1201

Mailing address

1441 N Beckley Ave
Dallas, TX 75203-1201
Phone (214) 947-2385

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190927001294 TX Practitioner - Internal Medicine 1355671744 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MedhealthGroup PAC ID 9931001567, 435 clinicians

Practice addresses (Care Compare)

421 E State Hwy 114
Southlake, TX 76092-3635
Phone (817) 865-4400

Hospital & facility affiliations

  • Methodist Dallas Medical Center Hospital, Dallas, TX, CCN 450051

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
S3511TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medhealth CurrentSince Oct 1, 2020 Accepting new patients
Medhealth Internal Medicine Current Accepting new patients
Physician Associates of Southwest Dallas Internal Medicine CurrentSince Sep 23, 2019 Accepting new patients
Methodist Hospitals of Dallas Past Accepting new patients

Locations

221 W Colorado Blvd
Dallas, TX 75208
Phone (214) 941-7200

1441 N Beckley Ave
Dallas, TX 75203
Phone (214) 712-2429

122 W Colorado Blvd
Dallas, TX 75208
Phone (214) 947-6555

5224 S State Highway 360
Grand Prairie, TX 75052
Phone (972) 522-0691

421 E State Highway 114
Southlake, TX 76092
Phone (817) 865-4400

Interoperability endpoints

  • Direct secure messaging: mehtsham112647@dm.mhd.com

Organizations & group practices 4

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 1

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": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1831543842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N BECKLEY AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031201",
            "telephone_number": "214-947-2385",
            "fax_number": "214-947-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N BECKLEY AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031201",
            "telephone_number": "214-947-2385",
            "fax_number": "214-947-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHTSHAM",
        "first_name": "MARYAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S3511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.