Individual provider Active NPI

Mital M Patel, D.O.

  • Diagnostic Radiology Physician
  • Fort Worth, TX
National Provider Identifier
1376742049
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
P0269 Issued in TX
Practice address
1101 6TH Ave
Fort Worth, TX 76104-4306
Phone
(817) 336-4637
Fax
(817) 336-7719
NPI assigned
Jul 13, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 5101016463 MI
Diagnostic Radiology Physician 2085R0202X P0269 TX Primary

Addresses

Primary practice location

1101 6TH Ave
Fort Worth, TX 76104-4306

Mailing address

1101 6TH Ave
Fort Worth, TX 76104-4306
Phone (817) 336-4637

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111004000869 TX Practitioner - Diagnostic Radiology 8628240298 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101016463MIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Preferred Imaging of Amarillo, LLC CurrentSince Oct 1, 2014 Accepting new patients
Preferred Imaging of Plano, LLC CurrentSince Jun 9, 2016 Accepting new patients
Preferred Imaging of Irving LLC Diagnostic Radiology CurrentSince May 8, 2017 Accepting new patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Oct 1, 2016 Accepting new patients
Preferred Open MRI, LLC Diagnostic Radiology CurrentSince Jun 8, 2016 Accepting new patients
Preferred Imaging of Grapevine/Colleyville, LLC CurrentSince Jan 1, 2013 Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316995200000",
    "number": "1376742049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 6TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044306",
            "telephone_number": "817-336-4637",
            "fax_number": "817-336-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 6TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044306",
            "telephone_number": "817-336-4637",
            "fax_number": "817-336-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MITAL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-13",
        "last_updated": "2011-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "5101016463",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "P0269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.