Individual provider Active NPI

Rae Leen Hannah-Lyon, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1619499241
Registry record updated Mar 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP134481 Issued in TX
Practice address
1500 S Main St
Fort Worth, TX 76104-4917
Phone
(817) 702-5553
NPI assigned
Jul 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP134481 TX Primary

Addresses

Primary practice location

1500 S Main St
Fort Worth, TX 76104-4917

Mailing address

1412 May St
Fort Worth, TX 76104-7639
Phone (817) 702-3431

Other names 1

  • Rae Leen Hannah Former name

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
I20180306002627 TX Practitioner - Nurse Practitioner 2163783242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.41
Promoting interoperability
100
Improvement activities
40
Cost
78.69

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
69350TXMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Acclaim Physician Group, Inc CurrentSince Jan 30, 2018 Accepting new patients

Locations

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

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

1412 May St
Ft Worth, TX 76104
Phone (817) 625-8818

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.

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519862400000",
    "number": "1619499241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 MAY ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047639",
            "telephone_number": "817-702-3431",
            "fax_number": "817-927-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAH-LYON",
        "first_name": "RAE",
        "middle_name": "LEEN",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-14",
        "last_updated": "2018-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP134481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAE",
            "last_name": "HANNAH",
            "middle_name": "LEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.