Individual provider Active NPI

Hasan Pham

  • Acute Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1396458337
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1099375 Issued in TX
Practice address
1900 Mistletoe Blvd
Fort Worth, TX 76104-4050
Phone
(817) 338-1300
Fax
(817) 338-1300
NPI assigned
Jan 5, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1099375 TX Primary

Addresses

Primary practice location

1900 Mistletoe Blvd
Fort Worth, TX 76104-4050

Mailing address

1900 Mistletoe Blvd
Fort Worth, TX 76104-4050
Phone (682) 557-0111

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
I20230223001274 TX Practitioner - Nurse Practitioner 2466825369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

515 W Mayfield Rd
Suite 240
Arlington, TX 76014-2084
Phone (817) 335-5288

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.25 of 100Reported as group
Promoting interoperability
85
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Pulmonary & Critical Care Consultants, PA CurrentSince Jul 2, 2024 Accepting new patients
Texas Pulmonary & Critical Care Consultants, PA PastSince Jul 2, 2024 Accepting new patients

Locations

515 W Mayfield Rd
Ste 240
Arlington, TX 76014
Phone (469) 301-1725

1201 Fairmount Ave
Fort Worth, TX 76104
Phone (817) 335-5288

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72070

Organizations & group practices 2

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 4

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": "1672876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1396458337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044050",
            "telephone_number": "682-557-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044050",
            "telephone_number": "817-338-1300",
            "fax_number": "817-338-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "HASAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1099375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.