Ishani Thakkar
Individual provider Active NPI Physician Assistant · Bedford, TX
NPI 1902593577 · NPPES record last updated Jul 27, 2026
Key facts
- NPI
- 1902593577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1615 Hospital Pkwy Ste 202
Bedford, TX 76022-5935 - Phone
- (817) 786-8686
- NPI assigned
- Apr 24, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250505001336 | TX | Practitioner - Physician Assistant | 2264959147 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085.012250 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | MO | ||
| Physician Assistant | 363A00000X | TX | Yes |
Addresses
Primary practice location
1615 Hospital Pkwy Ste 202
Bedford, TX 76022-5935
Mailing address
1615 Hospital Pkwy Ste 202
Bedford, TX 76022-5935
Other practice location 1
501 Davis St
Evanston, IL 60201-4619
Phone (312) 546-4193
Other providers in Bedford, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.