NPIMap

Organization Active NPI

Quang Trong Le DO PA

Doing business as River Park Medical Clinic

  • Internal Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1417954389
Registry record updated Jan 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
QUANG TRONG LE DO PA
Doing business as
River Park Medical Clinic
Practice address
2550 River Park PLZ
Suite 110
Fort Worth, TX 76116-0920
Phone
(817) 731-1289
Fax
(817) 731-1291
NPI assigned
Jul 7, 2005
Last updated
Jan 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2019

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

Authorized official

Name
Dr. Quang Trong Le, DO
Title
DO/Owner
Phone
(817) 731-1289

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Internal Medicine Physician 207R00000X Primary
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

2550 River Park PLZ
Suite 110
Fort Worth, TX 76116-0920

Mailing address

2550 River Park PLZ
Suite 110
Fort Worth, TX 76116-0920
Phone (817) 731-1289

Other identifiers 1

IdentifierTypeStateIssuer
168553902MedicaidTX

Other names 1

  • River Park Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041113000052 TX Part B Supplier - Clinic/Group Practice 6800850470 Receives reassigned benefits from 16 practitioners
Practice locations: Fort Worth, TX

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
45D1028889Quang Trong Le DO, PA2550 River Park Dr, Suite 110, Fort Worth, TX 76116Provider-performed microscopyAug 3, 2026

National Provider Directory

National Provider Directory

Locations

6301 Overton Ridge Blvd
Fort Worth, TX 76132
Phone (817) 292-5600

2550 River Park Plz
Ste 110
Ft Worth, TX 76116
Phone (817) 731-1289

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1417954389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 RIVER PARK PLZ",
            "address_2": "SUITE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160920",
            "telephone_number": "817-731-1289",
            "fax_number": "817-731-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 RIVER PARK PLZ",
            "address_2": "SUITE 110",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761160920",
            "telephone_number": "817-731-1289",
            "fax_number": "817-731-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUANG TRONG LE DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "QUANG TRONG",
        "authorized_official_title_or_position": "DO/OWNER",
        "authorized_official_telephone_number": "817-731-1289",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168553902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Park Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "River Park Medical Clinic",
            "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 Jan 8, 2019; 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.