Individual provider Active NPI

Nathaniel Ian Berrios, P.A.-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1619309101
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA08529 Issued in TX
Practice address
5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448
Phone
(817) 732-2878
NPI assigned
Aug 6, 2013
Last updated
Apr 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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 PA08529 TX Primary

Addresses

Primary practice location

5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448

Mailing address

5750 W Vickery Blvd Ste 104
Fort Worth, TX 76107-7448
Phone (817) 732-2878

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
I20160427001246 TX Practitioner - Physician Assistant 0749589638 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Huguley Emergency Physicians, LLPGroup PAC ID 3072562446, 22 clinicians
Integrative Emergency Services Physician Group PAGroup PAC ID 0749447936, 71 clinicians
Green Oaks Physical Therapy Limited PartnershipGroup PAC ID 4688582141, shared by 2 NPIs, 208 clinicians

Practice addresses (Care Compare)

11801 S Fwy
Burleson, TX 76028-7021
Phone (817) 293-9110

1500 S Main St
1St FL Outpatient
Ft. Worth, TX 76104-4917
Phone (817) 702-3431

1575 S Main St
JPS Emergency
Fort Worth, TX 76104-4901
Phone (817) 702-8828

350 Mercedes St
Benbrook, TX 76126-2593
Phone (817) 717-5390

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA08529TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince May 1, 2022 Accepting new patients
Texas Health Physicians Group CurrentSince May 1, 2022 Accepting new patients
Chisholm Trail Orthopedics & Sports Medicine, LLLP CurrentSince Mar 17, 2016 Accepting new patients
Chisholm Trail Emergency Center Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

2010 W Katherine P Raines Rd
Ste 300
Cleburne, TX 76033
Phone (817) 556-3212

5750 W Vickery Blvd
Ste 104
Fort Worth, TX 76107
Phone (817) 732-2878

Organizations & group practices 9

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.

Hospital & facility affiliations 3

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": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1619309101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 W VICKERY BLVD STE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077448",
            "telephone_number": "817-732-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 W VICKERY BLVD STE 104",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077448",
            "telephone_number": "817-732-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRIOS",
        "first_name": "NATHANIEL",
        "middle_name": "IAN",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-06",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.