NPIMap

Individual provider Active NPI

Vitaly Golub, MD

  • Infectious Disease Physician
  • Fort Worth, TX
National Provider Identifier
1346404993
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
P6399 Issued in TX
Practice address
1500 S Main St
Fort Worth, TX 76104-4917
Phone
(817) 702-3431
NPI assigned
Jul 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X P6399 TX Primary

Addresses

Primary practice location

1500 S Main St
Fort Worth, TX 76104-4917

Mailing address

1500 S Main St
Fort Worth, TX 76104-4917
Phone (817) 702-3431

Other identifiers 1

IdentifierTypeStateIssuer
03295778MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130814000915 TX Practitioner - Infectious DiseasePractitioner - Internal Medicine 8022294081 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
State University of New York Downstate Medical Center, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Acclaim Physician Group Inc 520 clinicians
Complete Infectious Diseases Care Associates, PLLC 2 clinicians

Practice addresses (Care Compare)

1350 S Main St FL
1 Healing Wings/Infectious Disease
Fort Worth, TX 76104-7611
Phone (817) 702-3701

4351 Booth Calloway Rd
Suite 404
North Richland Hills, TX 76180-7381
Phone (817) 294-6054

Hospital & facility affiliations

  • JPS Health Network Hospital, Fort Worth, TX, CCN 450039
  • Medical City Fort Worth Hospital, Fort Worth, TX, CCN 450672
  • Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135
  • Baylor Scott and White All Saints Medical Center Hospital, Fort Worth, TX, CCN 450137
  • Texas Health Presbyterian Hospital Plano Hospital, Plano, TX, CCN 450771

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.41
Promoting interoperability
100
Improvement activities
40
Cost
78.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P6399TXMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince May 1, 2016 Accepting new patients
Complete Infectious Diseases Care Associates, PLLC Infectious Disease CurrentSince May 1, 2018 Accepting new patients
Infectious Disease Associates LLP Infectious Disease Past Accepting new patients
AIDS Healthcare Foundation Texas Inc PastSince Jul 1, 2017 Accepting new patients

Locations

11803 South Fwy
Ste 202
Burleson, TX 76028
Phone (817) 349-9500

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1307 8th Ave
Ste 106
Fort Worth, TX 76104
Phone (817) 294-6054

800 8th Ave
Ste 336
Fort Worth, TX 76104
Phone (817) 335-0368

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

4351 Booth Calloway Rd
Ste 404
North Richlnd Hls, TX 76180
Phone (817) 255-1069

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1346404993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLUB",
        "first_name": "VITALY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "P6399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03295778",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.