Individual provider Active NPI

Indran Cheng Liu, DO

  • Pediatrics Physician
  • Fort Worth, TX
National Provider Identifier
1245767334
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
S5972 Issued in TX
Practice address
6421 McCart Ave
Fort Worth, TX 76133-4702
Phone
(817) 263-7500
NPI assigned
May 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X S5972 TX Primary

Addresses

Primary practice location

6421 McCart Ave
Fort Worth, TX 76133-4702

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-1855

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address iliu160559@CookChildrens.direct-ci.com

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
I20200702000344 TX Practitioner - Pediatric Medicine 3375813694 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children'S Physician Network Pediatrics CurrentSince Aug 3, 2020 Accepting new patients
Cook Children'S Physician Network Pediatrics CurrentSince Aug 3, 2020 Accepting new patients
Cook Children'S Medical Center Past Accepting new patients

Locations

6825 Manhattan Blvd
Ste 106
Fort Worth, TX 76120
Phone (682) 303-6825

6421 McCart Ave
Fort Worth, TX 76133
Phone (817) 263-7500

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

Interoperability endpoints

  • Direct secure messaging: iliu160559@cookchildrens.direct-ci.com

Organizations & group practices 3

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": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1245767334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6421 MCCART AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761334702",
            "telephone_number": "817-263-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "INDRAN",
        "middle_name": "CHENG",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-19",
        "last_updated": "2021-04-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "S5972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iliu160559@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "6421 McCart Ave",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761334702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.