NPIMap

Organization Active NPI

AIDS Outreach Center

  • Community/Behavioral Health Agency
  • Fort Worth, TX
National Provider Identifier
1285761999
Registry record updated Mar 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
NA Issued in TX
Legal business name
AIDS OUTREACH CENTER
Practice address
400 North Beach Street
Fort Worth, TX 76111
Phone
(817) 335-1994
Fax
(817) 335-3617
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2015

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

Authorized official

Name
Ms. Mellisand Le Roy
Title
Associate Executive Director
Phone
(817) 335-1994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NA TX Primary

Addresses

Primary practice location

400 North Beach Street
Fort Worth, TX 76111

Mailing address

400 North Beach Street
Fort Worth, TX 76111
Phone (817) 335-1994

Other identifiers 3

IdentifierTypeStateIssuer
109329601MedicaidTX
109329602MedicaidTX
TXB112740OtherTXMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719000984 TX Part B Supplier - Clinic/Group Practice 5991784308 Receives reassigned benefits from 2 practitioners
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

400 N Beach St
Ste 100
Ft Worth, TX 76111
Phone (817) 335-1994

801 W Cannon St
Ft Worth, TX 76104
Phone (817) 250-7195

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1285761999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NORTH BEACH STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76111",
            "telephone_number": "817-335-1994",
            "fax_number": "817-335-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NORTH BEACH STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76111",
            "telephone_number": "817-335-1994",
            "fax_number": "817-335-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AIDS OUTREACH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "LE ROY",
        "authorized_official_first_name": "MELLISAND",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "817-335-1994",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109329601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109329602",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "TXB112740",
            "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 Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.