Individual provider Active NPI

Christopher Michael Humphrey, DMSC, MPAS, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1538319280
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11002 Issued in TX
Practice address
1000 Lipscomb St
Fort Worth, TX 76104-3180
Phone
(817) 348-8600
NPI assigned
Sep 30, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11002 TX Primary

Addresses

Primary practice location

1000 Lipscomb St
Fort Worth, TX 76104-3180

Mailing address

1000 Lipscomb St
Fort Worth, TX 76104-3180

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
I20170919000196 TX Practitioner - Physician Assistant 5991079741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ved V Aggarwal MD PAGroup PAC ID 3072592252, 11 clinicians

Practice addresses (Care Compare)

1000 Lipscomb St
Suite 110
Fort Worth, TX 76104-3181
Phone (817) 348-8600

110 Mary Lou Dr
Suite 100
Willow Park, TX 76087-8767
Phone (817) 348-8600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ved V Aggarwal MD PA CurrentSince Jun 1, 2020 Accepting new patients
Ved V Aggarwal MD PA CurrentSince Jun 1, 2020 Accepting new patients
Florida Pain & Rehabilitation Institute Inc Past Accepting new patients
Ved V Aggarwal MD PA Past Accepting new patients
Ved V Aggarwal MD PA PastSince Sep 1, 2020 Accepting new patients

Locations

1000 Lipscomb St
Ste 110
Ft Worth, TX 76104

110 Mary Lou Dr
Ste 100
Willow Park, TX 76087
Phone (817) 423-5611

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1538319280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 LIPSCOMB ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 LIPSCOMB ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043180",
            "telephone_number": "817-348-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "CHRISTOPHER",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DMSC, MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-30",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.