Fort Worth Dermatology Center, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

Q6500 Issued in TX

Legal business name

FORT WORTH DERMATOLOGY CENTER, PLLC

Practice address

6900 Harris Pkwy
Suite 200
Fort Worth, TX 76132-4255

Phone

(956) 740-8650

NPI assigned

May 23, 2016

Organization subpart

No

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

Authorized official

Name

Bryan Jerry Carroll, MDNPI 1134486582

Title

Physician, Partner

Phone

(956) 740-8650

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan J Carroll, M.D.

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1134486582
  Medicare reassignment Care Compare group NPD Authorized official
• Roselynn H Nguyen, M.D.

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1346507704
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1245687987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 HARRIS PKWY",
            "address_2": "SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 HARRIS PKWY",
            "address_2": "SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324255",
            "telephone_number": "956-740-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH DERMATOLOGY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "JERRY",
        "authorized_official_title_or_position": "PHYSICIAN, PARTNER",
        "authorized_official_telephone_number": "956-740-8650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "Q6500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.