NPIMap

Individual provider Active NPI

Fidelis Kanayo Unini, MD

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1083654438
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M5959 Issued in TX
Practice address
609 Hemphill St.
Suite 101
Fort Worth, TX 76104-4137
Phone
(817) 923-8484
Fax
(817) 923-8494
NPI assigned
Jun 7, 2006
Last updated
Apr 16, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 239922 NY
Internal Medicine Physician 207R00000X M5959 TX Primary

Addresses

Primary practice location

609 Hemphill St.
Suite 101
Fort Worth, TX 76104-4137

Mailing address

609 Hemphill St.
Suite 101
Fort Worth, TX 76104-4137
Phone (817) 923-8484

Other identifiers 7

IdentifierTypeStateIssuer
7116498OtherAETNA
P01001955OtherBLUE SHIELD
02496142MedicaidNY
118542BJOtherPREFERRED CARE
00092354001OtherHEALTHNOW
P01001955OtherEXCELLUS
2591789OtherGROUP HEALTH INCORP.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070707000066 TX Practitioner - Internal Medicine 5092617639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legend Internal Medicine, Urgent Care and DiagnosticGroup PAC ID 3476653312, 2 clinicians

Practice addresses (Care Compare)

609 Hemphill St
Suite 101
Fort Worth, TX 76104-3149
Phone (817) 923-8484

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
239922NYMDInternal Medicine Physician
M5959TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Plaza Medical Center of Fort Worth Subsidiary LP Past Accepting new patients
Baylor All Saints Medical Center Past Accepting new patients
Decatur Hospital Authority Past Accepting new patients
Department of Medicine Faculty Practice Internal Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IIDFDD/Endpoint/IIDFDD

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, 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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1083654438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 HEMPHILL ST.",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044137",
            "telephone_number": "817-923-8484",
            "fax_number": "817-923-8494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 HEMPHILL ST.",
            "address_2": "SUITE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044137",
            "telephone_number": "817-923-8484",
            "fax_number": "817-923-8494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNINI",
        "first_name": "FIDELIS",
        "middle_name": "KANAYO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "239922",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "M5959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7116498",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "P01001955",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02496142",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "118542BJ",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNOW",
            "identifier": "00092354001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "P01001955",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH INCORP.",
            "identifier": "2591789",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.