Individual provider Active NPI

Samantha Marie Watts, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1043877384
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12869 Issued in TX
Practice address
1250 8TH Ave Ste 200
Fort Worth, TX 76104-4158
Phone
(817) 912-8240
NPI assigned
May 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 193400000X TX
Physician Assistant 363A00000X PA12869 TX Primary

Addresses

Primary practice location

1250 8TH Ave Ste 200
Fort Worth, TX 76104-4158

Mailing address

3408 Grants LNDG
Fort Worth, TX 76179-3853
Phone (435) 659-9821

Other names 1

  • Samantha Marie Wall Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190917002737 TX Practitioner - Physician Assistant 6800125881 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1307 8TH Ave
Suite 406
Fort Worth, TX 76104-4141
Phone (817) 912-8040

1400 8TH Ave
Fort Worth, TX 76104-4110

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8518
Phone (817) 921-6166

Hospital & facility affiliations

  • Baylor Scott and White All Saints Medical Center Hospital, Fort Worth, TX, CCN 450137

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
193400000XTXMDDevelopmentally Disabled Services Day Training Agency
PA12869TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Jul 5, 2022 Accepting new patients
Healthtexas Provider Network CurrentSince Jul 5, 2022 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

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

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

301 N Washington Ave
Dallas, TX 75246
Phone (469) 800-8330

1250 8th Ave
Ste 200
Fort Worth, TX 76104
Phone (817) 912-8020

Interoperability endpoints

  • Direct secure messaging: smorgan517795@direct.sw.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1043877384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 GRANTS LNDG",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761793853",
            "telephone_number": "435-659-9821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044158",
            "telephone_number": "817-912-8240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "193400000X",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "WALL",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.