Martin Luther King Jr Family Clinic

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MARTIN LUTHER KING JR FAMILY CLINIC

Practice address

2922 Martin Luther King Jr Blvd
Building B
Dallas, TX 75215-2321

Phone

(214) 426-3645

Fax

(214) 446-2018

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Joyce Tapley, CEO

Title

Chief Executive Officer

Phone

(214) 426-3645

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Enrolled in TX6 enrollments

Enrollment records 6

Federally qualified health center certification: CCN 451816

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 25, 1985

Enrollment address

2922 Martin Luther King Jr Blvd B
Dallas, TX 75215-2321

Federally qualified health center certification: CCN 741838

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 3, 2014

Last certification

Apr 3, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 25, 1985 in TX

Enrollment address

3515 Shepherd LN
Balch Springs, TX 75180-2325

Federally qualified health center certification: CCN 451191

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 20, 2022

Last certification

May 20, 2022

Ownership / control type

For profit – corporation

Organization structure

OtherNon-profit

Enrollment address

10327 Rylie Rd
Ofc 4
Dallas, TX 75217-8240

Federally qualified health center certification: CCN 971016

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Doing business as

FOREMOST FAMILY HEALTH CENTERS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 15, 2024

Last certification

Aug 15, 2024

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Mar 4, 2024 in TX

Enrollment address

2727 Al Lipscomb Way
Dallas, TX 75215

Federally qualified health center certification: CCN 971017

Legal name

MARTIN LUTHER KING JR FAMILY CLINIC

Doing business as

FOREMOST FAMILY HEALTH CENTERS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 15, 2024

Last certification

Aug 15, 2024

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 3, 2023 in TX

Enrollment address

8501 Bruton Rd
Dallas, TX 75217-1909

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Martin Luther King Jr Family Clinic

  • Clinic Pharmacy
  • Dallas, TX
  • NPI 1134366289

  O20111201000398

  Same enrollment

Locations

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 35

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

• Sherry Lynn Bowers, D.P.M.

  • Podiatrist
  • Fort Worth, TX
  • NPI 1538253083
  Medicare reassignment Care Compare group NPD
• Kimberly Michelle Dobbins, MD

  • Psychiatry Physician
  • Richardson, TX
  • NPI 1013111343
  Medicare reassignment Care Compare group NPD
• Michael Emeka Esedebe, MD

  • Obstetrics & Gynecology Physician
  • Dallas, TX
  • NPI 1952410037
  Medicare reassignment Care Compare group NPD
• Jocelyn Marie Hicks, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1396276234
  Medicare reassignment Care Compare group NPD
• Dorothy Chestine Marshall, M.D, M.P.H

  • Family Medicine Physician
  • Balch Springs, TX
  • NPI 1023471927
  Medicare reassignment Care Compare group NPD
• John Alan Black, LCSW

  • Clinical Social Worker
  • Skokie, IL
  • NPI 1225330277

  TX

  Medicare reassignment Care Compare group NPD
• Brandi Burnett

  • Family Nurse Practitioner
  • Denton, TX
  • NPI 1538668546
  Medicare reassignment NPD
• Anita Irin Dsouza

  • Family Nurse Practitioner
  • Balch Springs, TX
  • NPI 1558860528
  Medicare reassignment NPD
• Briana Echols, PA-C

  • Physician Assistant
  • Balch Springs, TX
  • NPI 1407440977
  Medicare reassignment NPD
• Stella Namaemba Kingodi, FNP-C

  • Acute Care Nurse Practitioner
  • Denton, TX
  • NPI 1013490754
  Medicare reassignment NPD
• Antonia Deanitra Martin, APRN, WHNP-BC

  • Women's Health Nurse Practitioner
  • Dallas, TX
  • NPI 1376256164
  Medicare reassignment NPD
• Sasheen Nicholas, LCSW

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1255221628
  Medicare reassignment NPD

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1851492557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2922 MARTIN LUTHER KING JR BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752152321",
            "telephone_number": "214-426-3645",
            "fax_number": "214-446-2018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 MARTIN LUTHER KING JR BLVD",
            "address_2": "BUILDING B",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752152321",
            "telephone_number": "214-426-3645",
            "fax_number": "214-446-2018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LUTHER KING JR FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "TAPLEY",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-426-3645",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713406",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713412",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183600",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "TXB104577",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713404",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713410",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "183600",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713409",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "QQ04",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130713408",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1949",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martin H. Schaffer M.D.,P.a.
• Maureen Virginia Martin Jamieson, DC
• Martin Luther King Jr Family Clinic
• Martin Luther King Jr Family Clinic
• Martin Luther King Jr Family Clinic
• Martin McElya DO PA (Neighborhood Medical Center)
• Martin S.Posner MD Associated
• Leidy Daniela Martin Samudio
• Martin Weinberg DDS Inc
• Gail Martin-Charles, CRNA

• Federally Qualified Health Center (FQHC) in Dallas, TX
• Providers in Dallas, TX by specialty
• Federally Qualified Health Center (FQHC) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.