Active NPI
Ross Tatum, M.D.
- Psychiatry Physician
- Ft Worth, TX
National Provider Identifier
1366524993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- J0303
- Practice address
- 3815 Lisbon St Ste 200
Ft Worth, TX 76107-5673 - Phone
- (817) 989-1122
- Fax
- (817) 989-2072
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | J0303 | TX | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | J0303 | TX |
Addresses
Primary practice location
3815 Lisbon St Ste 200
Ft Worth, TX 76107-5673
Mailing address
3815 Lisbon St Ste 200
Ft Worth, TX 76107-5673
Phone (817) 989-1122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P000T42H2 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J0303 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391990400000",
"number": "1366524993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3815 LISBON ST STE 200",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761075673",
"telephone_number": "817-989-1122",
"fax_number": "817-989-2072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3815 LISBON ST STE 200",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761075673",
"telephone_number": "817-989-1122",
"fax_number": "817-989-2072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATUM",
"first_name": "ROSS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-20",
"last_updated": "2014-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "J0303",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "TX",
"license": "J0303",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P000T42H2",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ft Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.