Active NPI
Lauren Grace Dobbs, PA
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1104019322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA05382
- Practice address
- 855 Montgomery St
Fort Worth, TX 76107-2553 - Phone
- (817) 735-0349
- Fax
- (817) 735-2653
- NPI assigned
- Aug 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA05382 | TX | Primary |
| Medical Physician Assistant | 363AM0700X | 2283 | OK |
Addresses
Primary practice location
855 Montgomery St
Fort Worth, TX 76107-2553
Mailing address
PO Box 99335
Fort Worth, TX 76199-0335
Phone (817) 735-0349
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191359201 | Medicaid | TX | |
| 8Y8724 | Other | TX | BCBS |
Other names 1
- Lauren Grace Fallis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2283 | OK | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of North Texas Health Science Center at Fort Worth | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Fort Worth, TX
- NPI 1417054024
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481241600000",
"number": "1104019322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99335",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990335",
"telephone_number": "817-735-0349",
"fax_number": "817-735-2653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 MONTGOMERY ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072553",
"telephone_number": "817-735-0349",
"fax_number": "817-735-2653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOBBS",
"first_name": "LAUREN",
"middle_name": "GRACE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-21",
"last_updated": "2016-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA05382",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OK",
"license": "2283",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "191359201",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8Y8724",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LAUREN",
"last_name": "FALLIS",
"middle_name": "GRACE",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.