NPIMap

Organization Active NPI

Usmd Diagnostic Services, LLC

  • Radiology Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1366977449
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
USMD DIAGNOSTIC SERVICES, LLC
Practice address
5450 Clearfork Main St
Suite 110
Fort Worth, TX 76109-3559
Phone
(817) 505-0222
Fax
(817) 510-3690
NPI assigned
Apr 26, 2017
Organization subpart
Yes
Parent organization
USMD HOLDINGS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2022

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

Authorized official

Name
Dr. Richard Coleman Johnston, M.D.
Title
Chief Executive Officer
Phone
(214) 493-4015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary
Physiological Laboratory 293D00000X

Addresses

Primary practice location

5450 Clearfork Main St
Suite 110
Fort Worth, TX 76109-3559

Mailing address

5450 Clearfork Main St
Suite 110
Fort Worth, TX 76109-3559
Phone (817) 505-0222

Other names 1

  • USMD Imaging Center at Clearfork Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050110000398 TX Part B Supplier - Clinic/Group Practice 9931157609 Receives reassigned benefits from 46 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Consultants in Radiology PA6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

811 W Interstate 20
Ste G22
Arlington, TX 76017
Phone (817) 468-3393

900 Airport Fwy
Ste 158
Hurst, TX 76054
Phone (817) 514-4000

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1493164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1366977449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 CLEARFORK MAIN ST",
            "address_2": "SUITE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761093559",
            "telephone_number": "817-505-0222",
            "fax_number": "817-510-3690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 CLEARFORK MAIN ST",
            "address_2": "SUITE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761093559",
            "telephone_number": "817-505-0222",
            "fax_number": "817-510-3690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USMD DIAGNOSTIC SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "USMD HOLDINGS, INC",
        "enumeration_date": "2017-04-26",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "COLEMAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-493-4015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USMD Imaging Center at Clearfork",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "USMD Imaging Center at Clearfork",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 20, 2022; 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.