NPIMap

Individual provider Active NPI

Abdolreza Siadati, MD

  • Neurological Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1033138011
Registry record updated Feb 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
L8956 Issued in TX
Practice address
1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4014
Phone
(817) 878-5333
Fax
(817) 878-5334
NPI assigned
Jul 19, 2006
Last updated
Feb 4, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X L8956 TX Primary

Addresses

Primary practice location

1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4014

Mailing address

1900 Mistletoe Blvd Ste 200
Fort Worth, TX 76104-4049
Phone (817) 878-5333

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
I20040812000847 TX Practitioner - Neurosurgery 5698747244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Indiana University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fort Worth Brain and Spine Institute, LLPGroup PAC ID 0840273868, 11 clinicians

Practice addresses (Care Compare)

1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4049
Phone (817) 878-5333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion268
Laminectomy or laminotomy (partial removal of spine bones)91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Nov 6, 2023 Accepting new patients
Healthtexas Provider Network CurrentSince Nov 6, 2023 Accepting new patients
Healthtexas Provider Network Current Accepting new patients
Fort Worth Brain & Spine Institute, LLP Neurological Surgery CurrentSince Aug 14, 2006 Accepting new patients
Clinical Neurological Associates of Dallas, LLP Neurological Surgery Past Accepting new patients
Texas Neuro Spine Institute, PA Neurological Surgery Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

1900 Mistletoe Blvd
Ste 200
Ft Worth, TX 76104

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

920 Santa Fe Dr
Ste 103
Weatherford, TX 76086
Phone (817) 339-8855

Interoperability endpoints

  • Direct secure messaging: asiadati@direct.uspi.com
  • Direct secure messaging: asiadati457930@direct.sw.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/DDBGCA

Organizations & group practices 6

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 10

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549238400000",
    "number": "1033138011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044049",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "address_2": "SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044014",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIADATI",
        "first_name": "ABDOLREZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2019-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "L8956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.