Fort Worth ENT,P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

H2007 Issued in TX

Legal business name

FORT WORTH ENT,P.A.

Doing business as

Fort Worth ENT, PA

Practice address

1250 8TH Ave
Suite 135
Fort Worth, TX 76104

Phone

(817) 335-8151

Fax

(817) 335-2670

NPI assigned

May 9, 2007

Last updated

Jan 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Vicky L. Vanvleck

Title

Practice Manager

Phone

(817) 335-8151

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• FORT WORTH ENT, PA Doing business as

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/69571

Practitioners 1

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.

• Todd E. Samuelson, M.D.

  • Otolaryngology Physician
  • Fort Worth, TX
  • NPI 1942308119
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1336353366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE",
            "address_2": "SUITE 135",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-335-8151",
            "fax_number": "817-335-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE",
            "address_2": "SUITE 135",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-335-8151",
            "fax_number": "817-335-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH ENT,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "VANVLECK",
        "authorized_official_first_name": "VICKY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "817-335-8151",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "H2007",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "L4150",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166927701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TODD E SAMUELSON MD LICEN",
            "identifier": "H2007",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TODD E. SAMUELSON MD BCBS",
            "identifier": "8G2131",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031074002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORT WORTH ENT, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.