Individual provider Active NPI

Amy C Philipp, DO

  • Pediatrics Physician
  • Fort Worth, TX
National Provider Identifier
1457432924
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
L2551 Issued in TX
Practice address
9840 N Beach St
Fort Worth, TX 76244-6184
Phone
(817) 431-3898
Fax
(817) 379-1161
NPI assigned
Oct 18, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X L2551 TX Primary

Addresses

Primary practice location

9840 N Beach St
Fort Worth, TX 76244-6184

Mailing address

PO Box 99371
Fort Worth, TX 76199-0371
Phone (682) 885-1855

Other identifiers 10

IdentifierTypeStateIssuer
146616104MedicaidTX
1958119OtherTXFIRSTHEALTH PIN
760027OtherTXAETNA PIN
8951478OtherTXCIGNA PIN
PHIA456738OtherTXCCHIP PIN
1750369203OtherGRP NPI NUMBER
00U87ZOtherTXBCBSTX GRP PIN
140543100OtherTXFIRSTCARE PIN
2115312OtherTXUHC PIN
84312SOtherTXBCBSTX IND PIN

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
I20090320000432 TX Practitioner - Pediatric Medicine 2062579998 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Children's Physician Network Pediatrics CurrentSince May 28, 2015 Accepting new patients
Cook Children's Physician Network Pediatrics CurrentSince May 28, 2015 Accepting new patients

Locations

4300 Heritage Trace Pkwy
Fort Worth, TX 76244
Phone (817) 431-3898

9840 N Beach St
Fort Worth, TX 76244
Phone (817) 431-3898

801 7th Ave
Ft Worth, TX 76104
Phone (682) 885-4054

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457432924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99371",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990371",
            "telephone_number": "682-885-1855",
            "fax_number": "682-885-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9840 N BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446184",
            "telephone_number": "817-431-3898",
            "fax_number": "817-379-1161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILIPP",
        "first_name": "AMY",
        "middle_name": "C",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L2551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146616104",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTHEALTH PIN",
            "identifier": "1958119",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "760027",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "8951478",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCHIP PIN",
            "identifier": "PHIA456738",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP NPI NUMBER",
            "identifier": "1750369203",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX GRP PIN",
            "identifier": "00U87Z",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE PIN",
            "identifier": "140543100",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC PIN",
            "identifier": "2115312",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX IND PIN",
            "identifier": "84312S",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.