Individual provider Active NPI

Spencer Sage Heath, DO

  • Student in an Organized Health Care Education/Training Program
  • Fort Worth, TX
National Provider Identifier
1215677455
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
V3319 Issued in TX
Practice address
1575 S Main St
Fort Worth, TX 76104-4901
Phone
(817) 702-8828
NPI assigned
Mar 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X V3319 TX Primary
Emergency Medicine Physician 207P00000X V3319 TX

Addresses

Primary practice location

1575 S Main St
Fort Worth, TX 76104-4901

Mailing address

4120 Tupelo TRL
Fort Worth, TX 76244-6929
Phone (682) 553-3536

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
I20250107004255 TX Practitioner - Emergency Medicine 9032647862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrative Emergency Services Physician Group PAGroup PAC ID 0749447936, 71 clinicians

Practice addresses (Care Compare)

1500 S Main St
1St FL Outpatient
Ft. Worth, TX 76104-4917
Phone (817) 702-3431

Hospital & facility affiliations

  • JPS Health Network Hospital, Fort Worth, TX, CCN 450039

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
V3319TXMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Emergency Services Physician Group PA Emergency Medicine CurrentSince Dec 3, 2024 Accepting new patients

Locations

1500 S Main St
Fl 1
Ft Worth, TX 76104
Phone (817) 702-1451

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

1575 S Main St
Ft Worth, TX 76104
Phone (817) 702-8828

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.

Hospital & facility affiliations 1

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": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1215677455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 TUPELO TRL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446929",
            "telephone_number": "682-553-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044901",
            "telephone_number": "817-702-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEATH",
        "first_name": "SPENCER",
        "middle_name": "SAGE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "V3319",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "V3319",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.