Fossil Creek Family Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FOSSIL CREEK FAMILY MEDICAL CENTER

Practice address

7510 N Beach St
Fort Worth, TX 76137

Phone

(817) 498-1818

Fax

(817) 581-3761

NPI assigned

Oct 11, 2006

Last updated

Mar 15, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Wayne Simonak, DONPI 1093735151

Title

Owner

Phone

(817) 498-1818

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Wayne Simonak, D.O.

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1093735151
  Medicare reassignment Care Compare group NPD Authorized official
• Brady Putnam Simonak, D.O.

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1821418658
  Medicare reassignment Care Compare group NPD
• Ryan David Simonak, D.O.

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1871721993
  Medicare reassignment Care Compare group NPD
• Timothy Hawley

  • Nurse Practitioner
  • Keller, TX
  • NPI 1720458896
  Medicare reassignment NPD
• Stephanie Heliot Edwards, PA-C

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1578088811
  Medicare reassignment
• Krista Nicole Watkins, PA

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1124585062
  Medicare reassignment
• Valerie Jones, PA-C

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1629343314
  NPD
• Hannah Kaye Payton, PA-C

  • Physician Assistant
  • Fort Worth, TX
  • NPI 1164873956
  NPD

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1639267982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7500 N BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761371505",
            "telephone_number": "817-498-1818",
            "fax_number": "817-581-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7510 N BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76137",
            "telephone_number": "817-498-1818",
            "fax_number": "817-581-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSSIL CREEK FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "SIMONAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-498-1818",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121142701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Forth Worth Surgical Associates PA
• Fortis Med Incorporated (Fortis Physicians)
• Fortworth Renal Group PA
• Wylie Tucker Foss, MD
• Fossil Creek Family Dental Care, PA
• Fossil Ridge Family Dentistry PLLC
• Fossil Ridge Family Dentistry PLLC
• Foster the Mind
• Amber Monique Foster, LCSW-S
• Antionette Foster, LPC

• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.