Organization Active NPI

Leon S Tio MD PA

Doing business as Clover Internal Medicine Associates

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1023581006
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LEON S TIO MD PA
Doing business as
Clover Internal Medicine Associates
Practice address
800 8TH Ave Ste 506
Fort Worth, TX 76104-2604
Phone
(817) 386-2679
Fax
(817) 386-3632
NPI assigned
Jan 2, 2019
Last updated
Jan 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Authorized official

Name
Dr. Elaine Phuah, DONPI 1366719767
Title
Medical Doctor
Phone
(214) 336-7643

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

800 8TH Ave Ste 506
Fort Worth, TX 76104-2604

Mailing address

800 8TH Ave Ste 506
Fort Worth, TX 76104-2604
Phone (817) 386-3632

Other names 1

  • Clover Internal Medicine Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190710000608 TX Part B Supplier - Clinic/Group Practice 4880929140 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Worth, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2176263Leon S Tio, MD, PA800 8TH Ave Suite 506, Fort Worth, TX 76104Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1023581006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 506",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042604",
            "telephone_number": "817-386-3632",
            "fax_number": "866-245-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 506",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042604",
            "telephone_number": "817-386-2679",
            "fax_number": "817-386-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEON S TIO MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-02",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "PHUAH",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "214-336-7643",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clover Internal Medicine Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.