Individual provider Active NPI

Shongerwi Chekenyere

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1376276618
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1130132 Issued in TX
Practice address
601 W Terrell Ave
Fort Worth, TX 76104-3243
Phone
(817) 702-3100
Fax
(817) 702-4847
NPI assigned
Jul 5, 2022
Last updated
Aug 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1130132 TX Primary
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X 954707 TX
Psychiatry Physician 2084P0800X 1130132 TX

Addresses

Primary practice location

601 W Terrell Ave
Fort Worth, TX 76104-3243

Mailing address

1708 Bardfield Ave
Garland, TX 75041-4921
Phone (817) 703-8313

Other practice location 1

1500 S Main St Fl 1
Fort Worth, TX 76104-4917
Phone (817) 702-3431

Other practice location 2

1500 S Main St Fl 2
Fort Worth, TX 76104-4917
Phone (817) 702-3636

Other practice location 3

1500 S Main St Fl 10
Fort Worth, TX 76104-4917
Phone (817) 702-4151

Other identifiers 1

IdentifierTypeStateIssuer
1130132OtherTXBOARD OF NURSING LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230818001716 TX Practitioner - Nurse Practitioner 7113389321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

601 W Terrell Ave
Fort Worth, TX 76104-3243
Phone (817) 702-3100

Hospital & facility affiliations

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
954707TXMDChild & Adolescent Psychiatric/Mental Health Registered Nurse
1130132TXMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince Aug 1, 2023 Accepting new patients

Locations

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

1500 S Main St
Fl 10
Fort Worth, TX 76104
Phone (817) 702-3636

1500 S Main St
Fl 1
Ft Worth, TX 76104
Phone (817) 702-1451

1500 S Main St
Fl 2
Ft Worth, TX 76104
Phone (817) 702-3000

200 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 702-2450

601 W Terrell Ave
Ft Worth, TX 76104
Phone (817) 338-4333

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1376276618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 BARDFIELD AVE",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750414921",
            "telephone_number": "817-703-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W TERRELL AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043243",
            "telephone_number": "817-702-3100",
            "fax_number": "817-702-4847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 S Main St Fl 1",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-3431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 S Main St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-3636",
            "fax_number": "817-927-8769",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 S Main St Fl 10",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044917",
            "country_code": "US",
            "telephone_number": "817-702-4151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHEKENYERE",
        "first_name": "SHONGERWI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-05",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1130132",
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "TX",
            "license": "954707",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "1130132",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF NURSING LICENSE",
            "identifier": "1130132",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.