Edward E Icaza MD PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

K9809 Issued in TX

Legal business name

EDWARD E ICAZA MD PA

Practice address

5801 Oakbend TRL Ste 270
Fort Worth, TX 76132-3922

Phone

(817) 615-9496

Fax

(855) 576-4158

NPI assigned

Oct 31, 2006

Organization subpart

No

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

Authorized official

Name

Edward Earl Icaza, MDNPI 1134121940

Title

President

Phone

(817) 615-9496

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Benbrook Neurology Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Earl Icaza, MD

  • Neurology Physician
  • Fort Worth, TX
  • NPI 1134121940
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1033295142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 OAKBEND TRL STE 270",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761323922",
            "telephone_number": "817-615-9496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 OAKBEND TRL STE 270",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761323922",
            "telephone_number": "817-615-9496",
            "fax_number": "855-576-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD E ICAZA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "ICAZA",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-615-9496",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "K9809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0072JA",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEUROLOGIST",
            "identifier": "K9809",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benbrook Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Educare Community Living Limited Partnership
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• Educare Therapy, LLC
• Edward L. Kramer, D.O., P.a.
• Edward N. Reiter, D.D.S., Inc.
• Edwards DFW
• Edwards Ranch Dental Group, PLLC
• Abena Dansoa Edwards, FNP-C

• Neurology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Neurology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.