Iberia Medical Clinic, P.a.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IBERIA MEDICAL CLINIC, P.A.

Doing business as

Southside Medical Clinic

Practice address

546 W Seminary Dr Ste a
Fort Worth, TX 76115-1361

Phone

(817) 924-7978

NPI assigned

Apr 2, 2007

Last updated

Apr 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pamela E Thomson

Title

Credentialing Manager

Phone

(817) 744-7524

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Southside Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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.

• Robert Lee Campbell, D.O.

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1992929947
  Medicare reassignment Care Compare group NPD
• Mirabel Sama, NP

  • Family Nurse Practitioner
  • Fort Worth, TX
  • NPI 1477426575
  Medicare reassignment Care Compare group NPD
• Terri L Speck, NP

  • Family Health Clinical Nurse Specialist
  • Burleson, TX
  • NPI 1437592748
  Medicare reassignment Care Compare group NPD
• Steven Sean Campbell, PA

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1891044780
  Medicare reassignment Care Compare group
• Micheal C Mendez, P.A.

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1952647422
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1043331812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 W SEMINARY DR STE A",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761151361",
            "telephone_number": "817-924-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 W SEMINARY DR STE A",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761151361",
            "telephone_number": "817-924-7978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBERIA MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "THOMSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "817-744-7524"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4172611-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4172611-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Helena Iannaccone, RN, ANP
• Juan Alejandro Ibarra, PHARM.D.
• Julio Jose Ibarra
• Stella Saenz Ibarra, LMT
• Yvette Ibarra, BS IONM
• Abigail Ibitoye, LPCA
• Marian Ibrahim
• Mohammad Taha Ibrahim, D.O.
• Youanna Ibrahim
• Ibrite Dental PLLC

• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.