Individual provider Active NPI

Kathleen Elise Cammack, M.D.

  • Obstetrics & Gynecology Physician
  • Fort Worth, TX
National Provider Identifier
1144586744
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
Q7156 Issued in TX
Practice address
1250 8TH Ave Ste 440
Fort Worth, TX 76104-4144
Phone
(817) 502-8484
Fax
(817) 212-7019
NPI assigned
Apr 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X Q7156 TX Primary

Addresses

Primary practice location

1250 8TH Ave Ste 440
Fort Worth, TX 76104-4144

Mailing address

P.O. Box 961205
Fort Worth, TX 76161-1205
Phone (817) 740-8400

Other identifiers 1

IdentifierTypeStateIssuer
358904601MedicaidTX

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
I20160616000305 TX Practitioner - Obstetrics/Gynecology 8921399296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Texas Medical School at Houston, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Care PLLCGroup PAC ID 7214840867, 363 clinicians

Practice addresses (Care Compare)

1250 8TH Ave
Suite 440
Fort Worth, TX 76104-4144
Phone (817) 923-5558

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q7156TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Care, P.L.L.C. CurrentSince Aug 1, 2016 Accepting new patients
Texas Health Care, P.L.L.C. Current Accepting new patients
Texas Health Care, P.L.L.C. Obstetrics & Gynecology CurrentSince Aug 1, 2016 Accepting new patients
Baylor All Saints Medical Center Past Accepting new patients

Locations

1250 8th Ave
Ste 440
Fort Worth, TX 76104
Phone (817) 502-8484

1250 8th Ave
Ste 430
Fort Worth, TX 76104
Phone (817) 923-0023

2821 Lackland Rd
Ste 300
Ft Worth, TX 76116
Phone (817) 740-8400

6700 Buenos Aires Dr
North Richlnd Hls, TX 76180
Phone (817) 281-8245

Interoperability endpoints

  • Direct secure messaging: kathleen.cammack.p1@direct.thc.nextgenshare.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1144586744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 961205",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761611205",
            "telephone_number": "817-740-8400",
            "fax_number": "817-378-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE STE 440",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044144",
            "telephone_number": "817-502-8484",
            "fax_number": "817-212-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMMACK",
        "first_name": "KATHLEEN",
        "middle_name": "ELISE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-09",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "Q7156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "358904601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.