NPIMap

Organization Active NPI

Fort Worth Family Practice Associated

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1356520134
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FORT WORTH FAMILY PRACTICE ASSOCIATED
Practice address
8030 Camp Bowie W
Fort Worth, TX 76116-6313
Phone
(817) 244-4620
NPI assigned
Oct 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Authorized official

Name
Sandra Ellis
Title
Office Manager
Phone
(817) 244-4620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X TX Primary

Addresses

Primary practice location

8030 Camp Bowie W
Fort Worth, TX 76116-6313

Mailing address

8030 Camp Bowie W
Fort Worth, TX 76116-6313
Phone (817) 244-4620

Other identifiers 2

IdentifierTypeStateIssuer
00436NOtherTXBCBS
8440J0OtherTXBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1356520134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8030 CAMP BOWIE W",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761166313",
            "telephone_number": "817-244-4620",
            "fax_number": "817-560-7159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8030 CAMP BOWIE W",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761166313",
            "telephone_number": "817-244-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH FAMILY PRACTICE ASSOCIATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-30",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "817-244-4620"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00436N",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8440J0",
            "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 Nov 11, 2009; 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.