Dorian Louis Jimenez, D.P.M.
Individual provider Active NPI Podiatrist · Southlake, TX
NPI 1952397119 · NPPES record last updated Jul 17, 2019
Key facts
- NPI
- 1952397119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 2397 (TX)
- Practice address
- 1940 Hwy 114 Suite 150
Southlake, TX 76092 - Phone
- (817) 424-3668
- Fax
- (817) 442-8637
- NPI assigned
- Sep 23, 2005
- Reactivated
- Mar 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Temple University School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ankle and Foot Centers of Georgia, LLC
Practice addresses (Care Compare)
1975 Beverly Rd
Suite B
Gainesville, GA 30501-2034
Phone (678) 902-0456
Hospital & facility affiliations
- Piedmont Walton Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.6 of 100
- Quality
- 88.21
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 83.78
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 180 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 296 |
| Removal or shaving of skin growth | 123 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050902000620 | GA | Practitioner - Podiatry | 3274565866 | Reassigns benefits to 1 organization |
| I20190827003605 | TX | Practitioner - Podiatry | 3274565866 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000998 | GA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Academy Foot & Ankle Specialists, P.a. | Podiatrist | Current |
Accepting new patients |
| Georgia Ambulatory Surgery Center LLC | Current | Accepting new patients | |
| Blue Water Anesthesia, LLC | Current | Accepting new patients | |
| Ankle and Foot Center of Georgia,LLC | Podiatrist | Past | Accepting new patients |
| A. Louis Jimenez, DPM, PC | Foot & Ankle Surgery | Past | Accepting new patients |
Locations
2175 North Rd
Snellville, GA 30078
Phone (770) 284-9171
1940 E State Highway 114
Ste 150
Southlake, TX 76092
Phone (817) 424-3688
Interoperability endpoints
- jimenez.dorian.017.0430232@as.meditab.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | POD000998 | GA | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 000998 | GA | |
| Podiatrist | 213E00000X | 2397 | TX | Yes |
Addresses
Primary practice location
1940 Hwy 114 Suite 150
Southlake, TX 76092
Mailing address
1940 Hwy 114 Suite 150
Southlake, TX 76092-3084
Phone (817) 424-3668
Other practice location 1
2295 Parklake Dr NE Ste 150
Atlanta, GA 30345-2825
Phone (770) 938-5974
Other practice location 2
3840 Peachtree Industrial Blvd
Suite 200
Duluth, GA 30096-5031
Phone (770) 979-0900
Other practice location 3
11459 Johns Creek Pkwy Ste 260
Johns Creek, GA 30097-3517
Phone (770) 232-5030
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 582964905A | Medicaid | GA | |
| P00427172 | Other | GA | RAILROAD MEDICARE PTAN |
Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2019. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.