NPIMap

Organization Active NPI

Heart Center of North Texas, PA

Doing business as Heart Center of North Texas

  • Cardiovascular Disease Physician
  • Fort Worth, TX
National Provider Identifier
1396762357
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
HEART CENTER OF NORTH TEXAS, PA
Doing business as
Heart Center of North Texas
Practice address
1017 12TH Ave
Fort Worth, TX 76104-3915
Phone
(817) 334-2800
Fax
(817) 820-0094
NPI assigned
Jul 16, 2006
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Sydney Madden
Title
Administrator
Phone
(817) 334-2800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary
Clinical Cardiac Electrophysiology Physician 207RC0001X NU
Interventional Cardiology Physician 207RI0011X NU

Addresses

Primary practice location

1017 12TH Ave
Fort Worth, TX 76104-3915

Mailing address

1017 12TH Ave
Fort Worth, TX 76104-3915
Phone (817) 334-2800

Other identifiers 3

IdentifierTypeStateIssuer
5930155OtherTXAETNA GROUP
00455KOtherTXBLUE CROSS BLUE SHIELD
109377504MedicaidTX

Other names 1

  • Heart Center of North Texas Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040612000161 TX Part B Supplier - Clinic/Group Practice 5092798694 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Worth, TX; Weatherford, TX

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1011918Heart Center of North Texas, PA1017 12TH Avenue, Fort Worth, TX 76104Certificate of waiverDec 10, 2027

National Provider Directory

National Provider Directory

Locations

312 E Renfro St
Burleson, TX 76028

1650 W Rosedale St
Fort Worth, TX 76104
Phone (817) 336-5185

1121 Pecan Dr
Weatherford, TX 76086
Phone (817) 341-7342

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1396762357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 12TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043915",
            "telephone_number": "817-334-2800",
            "fax_number": "817-820-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 12TH AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043915",
            "telephone_number": "817-334-2800",
            "fax_number": "817-820-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART CENTER OF NORTH TEXAS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "MADDEN",
        "authorized_official_first_name": "SYDNEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-334-2800"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP",
            "identifier": "5930155",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00455K",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109377504",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart Center of North Texas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.