Active NPI
Shelly M Harvey, MD
- Allergy & Immunology Physician
- Fort Worth, TX
National Provider Identifier
1255325403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- L4428
- Practice address
- 600 S Main St
Fort Worth, TX 76104 - Phone
- (817) 882-2400
- NPI assigned
- Sep 2, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | L4428 | TX | Primary |
Addresses
Primary practice location
600 S Main St
Fort Worth, TX 76104
Mailing address
PO Box 845347
Dallas, TX 75284-7208
Phone (817) 882-2400
Other practice location 1
7777 Forest Ln
B332
Dallas, TX 75230-6822
Phone (972) 566-7788
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200032380A | Medicaid | OK | |
| 1741256 | Medicaid | LA | |
| 8A9171 | Other | BCBS | |
| 1582256-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559174400000",
"number": "1255325403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 845347",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847208",
"telephone_number": "817-882-2400",
"fax_number": "972-566-8837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S MAIN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76104",
"telephone_number": "817-882-2400"
}
],
"practiceLocations": [
{
"address_1": "7777 Forest Ln",
"address_2": "B332",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "TX",
"postal_code": "752306822",
"country_code": "US",
"telephone_number": "972-566-7788",
"fax_number": "972-566-8837",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARVEY",
"first_name": "SHELLY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-02",
"last_updated": "2019-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "TX",
"license": "L4428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200032380A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1741256",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8A9171",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1582256-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; 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.