Individual provider Active NPI

Kathleen Louise Shide, MD

  • Radiation Oncology Physician
  • Fort Worth, TX
National Provider Identifier
1073550455
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
K3007 Issued in TX
Practice address
500 S Henderson St Ste 200
Fort Worth, TX 76104-2154
Phone
(174) 131-5008
Fax
(817) 413-1499
NPI assigned
Jun 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X K3007 TX Primary

Addresses

Primary practice location

500 S Henderson St Ste 200
Fort Worth, TX 76104-2154

Mailing address

PO Box 911230
Dallas, TX 75391-1230
Phone (972) 997-8000

Other identifiers 3

IdentifierTypeStateIssuer
8S3355OtherTXBLUE CROSS OF TEXAS
166057303MedicaidTX
166057302MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040722000945 TX Practitioner - Radiation Oncology 9638159379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Texas Southwestern Medical School at Dallas, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Oncology PAGroup PAC ID 5395658934, 1,001 clinicians

Practice addresses (Care Compare)

2026 S Jackson St
Jacksonville, TX 75766-5822
Phone (903) 586-2456

4201 Brown TRL
Suite 101
Colleyville, TX 76034-3941
Phone (682) 217-2102

500 S Henderson St
Fort Worth, TX 76104-2154
Phone (817) 413-1500

7848 Gateway Blvd E
El Paso, TX 79915-1815
Phone (915) 599-1313

907 Foster LN
Weatherford, TX 76086-5713
Phone (817) 597-7900

911 Foster LN
Weatherford, TX 76086-5713
Phone (817) 597-7900

Hospital & facility affiliations

  • Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as apm
Quality
67.48
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K3007TXMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Oncology PA Radiation Oncology CurrentSince Jul 1, 2005 Accepting new patients
Texas Oncology PA Radiation Oncology CurrentSince Jul 1, 2005 Accepting new patients
Texas Oncology PA Radiation Oncology Current Accepting new patients

Locations

4201 Brown Trl
Ste 101
Colleyville, TX 76034
Phone (682) 217-2102

7777 Forest Ln
Ste C707
Dallas, TX 75230
Phone (972) 566-3000

7848 Gateway Blvd E
El Paso, TX 79915
Phone (915) 599-1313

500 S Henderson St
Ste 100
Fort Worth, TX 76104
Phone (817) 413-1500

500 S Henderson St
Ste 200
Ft Worth, TX 76104
Phone (817) 413-1500

1450 8th Ave
Ft Worth, TX 76104
Phone (817) 702-8300

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

911 Foster Ln
Weatherford, TX 76086
Phone (817) 594-2052

Interoperability endpoints

  • Direct secure messaging: kathleen.shide@txo.ikm.direct-ci.com

Organizations & group practices 3

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": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1073550455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 911230",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753911230",
            "telephone_number": "972-997-8000",
            "fax_number": "972-437-9605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S HENDERSON ST STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042154",
            "telephone_number": "174-131-5008",
            "fax_number": "817-413-1499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIDE",
        "first_name": "KATHLEEN",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "TX",
            "license": "K3007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TEXAS",
            "identifier": "8S3355",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166057303",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166057302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.