Organization Active NPI

Angel's Star Wellness Center, P.a

  • Family Medicine Physician
  • Watauga, TX
National Provider Identifier
1457412710
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L0508 Issued in TX
Legal business name
ANGEL'S STAR WELLNESS CENTER, P.A
Practice address
8325 Whitley Rd
Suite: 100
Watauga, TX 76148-2487
Phone
(817) 479-1181
Fax
(817) 918-4432
NPI assigned
Dec 12, 2006
Last updated
Oct 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Authorized official

Name
Frank Nguyen
Title
Management
Phone
(817) 791-1811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L0508 TX Primary

Addresses

Primary practice location

8325 Whitley Rd
Suite: 100
Watauga, TX 76148-2487

Mailing address

8325 Whitley Rd
Suite: 100
Watauga, TX 76148-2487
Phone (817) 479-1181

Other identifiers 3

IdentifierTypeStateIssuer
0072PDOtherTXBCBS
DH2407OtherMEDICARE RAILROAD
191341001MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080124000692 TX Part B Supplier - Clinic/Group Practice 3870675150 Receives reassigned benefits from 1 practitioner
Practice locations: Watauga, 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
45D1102895Angel's Star Wellness Center, PA8325 Whitley Rd Suite100, Watauga, TX 76148Certificate of waiverJul 27, 2027

National Provider Directory

National Provider Directory

Locations

5040 North Tarrant Pkwy
#1
Fort Worth, TX 76244
Phone (817) 750-2777

8325 Whitley Rd
Ste 100
Watauga, TX 76148
Phone (817) 479-1181

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1457412710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8325 WHITLEY RD",
            "address_2": "SUITE: 100",
            "city": "WATAUGA",
            "state": "TX",
            "postal_code": "761482487",
            "telephone_number": "817-479-1181",
            "fax_number": "817-750-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8325 WHITLEY RD",
            "address_2": "SUITE: 100",
            "city": "WATAUGA",
            "state": "TX",
            "postal_code": "761482487",
            "telephone_number": "817-479-1181",
            "fax_number": "817-918-4432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL'S STAR WELLNESS CENTER, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "MANAGEMENT",
        "authorized_official_telephone_number": "817-791-1811"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L0508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0072PD",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DH2407",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191341001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watauga, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.