DELTA MEDICAL CLINIC
NPI 1073550919
Internal Medicine in Burleson, TX
About Delta Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DELTA MEDICAL CLINIC (NPI 1073550919) is a healthcare organization registered as an internal medicine in Burleson, Texas and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through January 14, 2028 and lists Kofoworola Ekadi, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Delta Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Delta Medical Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 45D1017853
Delta Medical PA Kofoworola Ekadi · Burleson, TXFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Delta Medical PA's NPI number?
The NPI number for Delta Medical PA is 1073550919. It was assigned to this organization in the NPPES registry on May 31, 2006. The provider is doing business as Delta Medical Clinic.
Where is Delta Medical PA located?
Delta Medical PA is located at 12001 South Fwy Suite 210, Burleson, TX 76028. The listed phone number is (817) 293-8797.
What is Delta Medical PA's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Delta Medical PA enrolled in Medicare?
Yes. Delta Medical PA is registered in the Medicare PECOS enrollment system.
When is Delta Medical PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Delta Medical PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Delta Medical PA, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Delta Medical PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 45D1017853) is associated with this NPI, valid through January 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Delta Medical PA was last updated on April 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Delta Medical Clinic · NPI 1073550919
Internal Medicine organization in Burleson, Texas. Organization record, active in the CMS NPPES registry since May 31, 2006.
## Identity
- **NPI:** 1073550919 (Entity type: Organization)
- **Enumerated:** May 31, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Delta Medical Pa
- **Organization subpart:** No
- **Authorized official:** Kofoworola Ekadi, PRESIDENT
## Practice location
- **Address:** 12001 SOUTH FWY, SUITE 210, Burleson, TX 76028-7208
- **Phone:** (817) 293-8797
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (1), Nurse Practitioner (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 8, 2023
- **Other identifiers:** Other 00W561 (TX); Other P00053593 (TX)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1073550919) · Data from the CMS NPPES public registry.