ABIGAIL JOY SODERDAHL (PA-C) – Medical Physician Assistant, NPI 1619775236

ABIGAIL JOY SODERDAHL (PA-C) is a healthcare provider. based in Fort worth, Texas. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. PA19046 (TX). The NPI Number for ABIGAIL JOY SODERDAHL (PA-C) is 1619775236

Main info

Female
Sole Proprietor
1 Year Of Experience
Accepts Medicare Assignment
Name
ABIGAIL JOY SODERDAHL (PA-C)
NPI
1619775236
Phone
(817) 871-9069
Address
2900 ACME BRICK PLZ
Enumeration Date
7 March 2025
Last Update Date
25 August 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8178719069
Graduation Year
2025 (1 year ago)
PAC ID
7214454065
Group Practice PAC ID
6002076882
Professional Enrollment ID
I20250506001705
Address ID
TX761094123FO2900XPLZX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness85
Years active:1State licenses:1Digital endpointsOther names

8,491 PHYSICIAN ASSISTANT in TX

Provider Addresses for ABIGAIL JOY SODERDAHL (PA-C)

  • 2900 ACME BRICK PLZ

    FORT WORTH, TX 761094123

    Phone: (817) 871-9069

    Type: Mailing

  • 11803 South Fwy Ste 346

    Burleson, TX 760287036

    Phone: (817) 769-3370

    Fax: (817) 769-3377

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-05-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250506001705IPhysician AssistantTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76109)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6002076882View full group profile
NameSpecialtyState
U R O L O G YNJ
U R O L O G YTX
Physician AssistantTX
Physician AssistantTX
U R O L O G YTX
U R O L O G YTX
Physician AssistantTX
Nurse PractitionerTX
Physician AssistantTX
U R O L O G YTX

Reviews

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Frequently asked questions

Can I cross-check ABIGAIL JOY SODERDAHL (PA-C) using NPI 1619775236?
NPI 1619775236 belongs to ABIGAIL JOY SODERDAHL (PA-C); compare other details if you need extra assurance.
Is there an active status for ABIGAIL JOY SODERDAHL (PA-C)?
For scheduling context, ABIGAIL JOY SODERDAHL (PA-C) is shown as active in the registry.
What kind of doctor is ABIGAIL JOY SODERDAHL (PA-C)?
ABIGAIL JOY SODERDAHL (PA-C) is associated with Medical Physician Assistant in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for ABIGAIL JOY SODERDAHL (PA-C)?
Travel planning: use Fort Worth, Texas as the reference point for ABIGAIL JOY SODERDAHL (PA-C), then confirm.
Does ABIGAIL JOY SODERDAHL (PA-C) accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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