Active NPI
Manuel Chavarria, PA
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1578614921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA05388
- Practice address
- 4200 South Fwy Ste 106
Fort Worth, TX 76115-1407 - Phone
- (817) 566-0505
- Fax
- (817) 566-0484
- NPI assigned
- Jan 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA05388 | TX | Primary |
Addresses
Primary practice location
4200 South Fwy Ste 106
Fort Worth, TX 76115-1407
Mailing address
122 W John Carpenter Fwy Ste 420
Irving, TX 75039-2014
Phone (972) 957-3000
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
229 NE 28TH St
Clinicas Mi Doctor
Fort Worth, TX 76164-7205
Phone (817) 566-0483
4200 S Fwy
106 Clinicas Mi Doctor
Ft Worth, TX 76115-1407
Phone (817) 566-0505
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Topcare Medical PA | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609286400000",
"number": "1578614921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 W JOHN CARPENTER FWY STE 420",
"city": "IRVING",
"state": "TX",
"postal_code": "750392014",
"telephone_number": "972-957-3000",
"fax_number": "972-957-3005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 SOUTH FWY STE 106",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761151407",
"telephone_number": "817-566-0505",
"fax_number": "817-566-0484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVARRIA",
"first_name": "MANUEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-14",
"last_updated": "2020-12-30",
"certification_date": "2020-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA05388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Dec 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.