Individual provider Active NPI

Shantel Johnson, FNP-C

  • Family Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1609611292
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1169611 Issued in TX
Practice address
200 W Magnolia Ave Ste 201
Fort Worth, TX 76104-7657
Phone
(817) 702-2933
Fax
(817) 702-7315
NPI assigned
Jun 26, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1169611 TX Primary

Addresses

Primary practice location

200 W Magnolia Ave Ste 201
Fort Worth, TX 76104-7657

Mailing address

17200 Westgrove Dr Apt 2421
Addison, TX 75001-7136
Phone (409) 548-1271

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
I20240906004004 TX Practitioner - Nurse Practitioner 3870033665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

3308 Deen Rd
Fort Worth, TX 76106-6524
Phone (817) 702-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince Aug 14, 2024 Accepting new patients

Locations

1050 W Arkansas Ln
Arlington, TX 76013
Phone (817) 277-6555

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

3308 Deen Rd
Ft Worth, TX 76106
Phone (817) 702-1819

200 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 702-2450

Organizations & group practices 1

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1609611292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17200 WESTGROVE DR APT 2421",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017136",
            "telephone_number": "409-548-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W MAGNOLIA AVE STE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047657",
            "telephone_number": "817-702-2933",
            "fax_number": "817-702-7315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANTEL",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1169611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.