NPIMap

Individual provider Active NPI

Kidane Tessema

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1912397613
Registry record updated May 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP126837 Issued in TX
Practice address
7929 Brookriver Dr Ste 180
Dallas, TX 75247-4920
Phone
(214) 525-0681
Fax
(972) 349-6595
NPI assigned
Feb 2, 2015
Last updated
May 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP126837 TX Primary

Addresses

Primary practice location

7929 Brookriver Dr Ste 180
Dallas, TX 75247-4920

Mailing address

1718 N Jupiter Rd Apt 2136
Garland, TX 75042-8625
Phone (214) 404-5238

Other practice location 1

4124 Gus Thomasson Rd
Suite B
Mesquite, TX 75150-2226
Phone (972) 850-9146

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150313001551 TX Practitioner - Nurse Practitioner 7416273271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sofia M Weigel MD PAGroup PAC ID 6406117134, 2 clinicians

Practice addresses (Care Compare)

7929 Brookriver Dr
Suite 180
Dallas, TX 75247-4920
Phone (214) 525-0681

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.26 of 100Reported as individual
Quality
25
Improvement activities
0
Cost
10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sofia M Weigel MD PA Single Specialty CurrentSince Dec 26, 2017 Accepting new patients
Lifevantage House Calls PLLC Single Specialty Past Accepting new patients
Occupational Home Healthcare, LLC Past Accepting new patients
Texans MD House Calls Management LLC Single Specialty PastSince Aug 1, 2014 Accepting new patients

Locations

7929 Brookriver Dr
Ste 180
Dallas, TX 75247
Phone (214) 525-0681

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1422835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1912397613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 N JUPITER RD APT 2136",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750428625",
            "telephone_number": "214-404-5238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7929 BROOKRIVER DR STE 180",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752474920",
            "telephone_number": "214-525-0681",
            "fax_number": "972-349-6595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4124 Gus Thomasson Rd",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Mesquite",
            "state": "TX",
            "postal_code": "751502226",
            "country_code": "US",
            "telephone_number": "972-850-9146",
            "fax_number": "972-863-9237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TESSEMA",
        "first_name": "KIDANE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-02",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP126837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.