Thomas Elden Deporter, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

H9063 Issued in TX

Practice address

6300 Ridglea PL Ste 415
Fort Worth, TX 76116-5706

Phone

(817) 377-1333

Fax

(817) 377-0420

NPI assigned

Mar 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Thomas Deporter, MD, PA

  • Medical Specialty Clinic/Center
  • Benbrook, TX
  • NPI 1407530413
  NPD Authorized official
• Huguley Medical Associates

  • General Practice Physician
  • Burleson, TX
  • NPI 1629290929
  NPD (past)

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174651004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 RIDGLEA PL STE 415",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165706",
            "telephone_number": "817-377-1333",
            "fax_number": "817-377-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 RIDGLEA PL STE 415",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761165706",
            "telephone_number": "817-377-1333",
            "fax_number": "817-377-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPORTER",
        "first_name": "THOMAS",
        "middle_name": "ELDEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "H9063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dentistry for Children PLLC
• Dentistry on Western Center
• Dentists at Chisholm Trail, PC
• Dentists of Eagle Mountain, PC
• Department of Veterans Affairs
• Depression Connection for Recovery
• Dept of Assistive & Rehab Serv - Fort Worth Field Headquarters
• Ivan Manuel Dequesada II, M.D.
• Morgan Ann Derby
• Maya Derhake, MS, CGC

• Psychiatry Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.