Individual provider Active NPI

Jeffery C McGlothlin, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Fort Worth, TX
National Provider Identifier
1104921873
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
H5469 Issued in TX
Practice address
1500 Cooper St
Fort Worth, TX 76104-2710
Phone
(682) 885-2500
Fax
(682) 885-2510
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X H5469 TX Primary

Addresses

Primary practice location

1500 Cooper St
Fort Worth, TX 76104-2710

Mailing address

PO Box 99371
Fort Worth, TX 76199-0371
Phone (682) 885-1855

Other identifiers 14

IdentifierTypeStateIssuer
123977OtherTXSUPERIOR PIN
4397262OtherTXAETNA PIN
10010109OtherTXAMERIGROUP PIN
87V784OtherTXBCBSTX IND PIN
9360939OtherTXCIGNA PIN
1750369203OtherTXGPR NPI NUMBER
00U87ZOtherTXBCBSTX GRP PIN
119063100OtherTXFIRSTCARE PIN
023247201MedicaidTX
120608801MedicaidTX
120608802MedicaidTX
140442803MedicaidTX
1436086OtherTXUHC PIN
1640340OtherTXFIRSTHEALTH PIN

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
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1104921873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99371",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990371",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 COOPER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042710",
            "telephone_number": "682-885-2500",
            "fax_number": "682-885-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGLOTHLIN",
        "first_name": "JEFFERY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "TX",
            "license": "H5469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR PIN",
            "identifier": "123977",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "4397262",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PIN",
            "identifier": "10010109",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX IND PIN",
            "identifier": "87V784",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "9360939",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GPR NPI NUMBER",
            "identifier": "1750369203",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX GRP PIN",
            "identifier": "00U87Z",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE PIN",
            "identifier": "119063100",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023247201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120608801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120608802",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140442803",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC PIN",
            "identifier": "1436086",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTHEALTH PIN",
            "identifier": "1640340",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.