Individual provider Active NPI

Tracy L Oeller, PA

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1053490425
Registry record updated Feb 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01476 Issued in TX
Practice address
6100 Lake Worth Blvd
Fort Worth, TX 76135-3703
Phone
(817) 237-3321
Fax
(817) 237-7970
NPI assigned
Nov 4, 2006
Last updated
Feb 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01476 TX Primary

Addresses

Primary practice location

6100 Lake Worth Blvd
Fort Worth, TX 76135-3703

Mailing address

6100 Lake Worth Blvd
Fort Worth, TX 76135-3703
Phone (817) 237-3321

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
I20100524000466 TX Practitioner - Physician Assistant 9830228246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

1600 Hospital Pkwy
Bedford, TX 76022-6913
Phone (817) 684-2708

251 Westpark Way
Suite 212
Euless, TX 76040-3707
Phone (214) 570-2319

6100 Lake Worth Blvd
Lake Worth, TX 76135-3703
Phone (817) 237-3321

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Jan 1, 2011 Accepting new patients
Texas Health Physicians Group CurrentSince Jan 1, 2011 Accepting new patients
Texas Health Physicians Group Past Accepting new patients
Physicians and Allied Health Professionals Group, PA Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

6048 Lake Worth Blvd
Fort Worth, TX 76135
Phone (817) 238-1950

4504 Boat Club Rd
Ste 800
Ft Worth, TX 76135
Phone (817) 237-0515

6100 Lake Worth Blvd
Lake Worth, TX 76135
Phone (817) 237-3321

341 Wheatfield Dr
Ste 100
Sunnyvale, TX 75182
Phone (972) 329-1996

Interoperability endpoints

  • Direct secure messaging: toeller1288331@direct.texashealth.org

Organizations & group practices 4

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 3

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": "1162598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1053490425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 LAKE WORTH BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761353703",
            "telephone_number": "817-237-3321",
            "fax_number": "817-237-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 LAKE WORTH BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761353703",
            "telephone_number": "817-237-3321",
            "fax_number": "817-237-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OELLER",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-04",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.