Individual provider Active NPI

Chiyon Carroll

  • Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1851037808
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1034109 Issued in TX
Practice address
400 W Magnolia Ave
Fort Worth, TX 76104-7617
Phone
(817) 288-9700
NPI assigned
May 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1034109 TX Primary

Addresses

Primary practice location

400 W Magnolia Ave
Fort Worth, TX 76104-7617

Mailing address

6000 Harry Hines Blvd Suite ND2.300
Dallas, TX 75390-8574

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
I20221020000053 TX Practitioner - Nurse Practitioner 6002282837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

2001 Inwood Rd
Dallas, TX 75390-7202
Phone (214) 645-0538

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1034109TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 1, 2022 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Aug 1, 2022 Accepting new patients

Locations

6000 Harry Hines Blvd
Ste ND2300
Dallas, TX 75235
Phone (214) 648-4673

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

400 W Magnolia Ave
Ft Worth, TX 76104
Phone (817) 288-9700

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

3030 Waterview Pkwy
Richardson, TX 75080
Phone (972) 669-7070

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

2001 Inwood Rd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-8000

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 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": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1851037808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 HARRY HINES BLVD SUITE ND2.300",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753908574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W MAGNOLIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047617",
            "telephone_number": "817-288-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CHIYON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1034109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.