Fort Worth Diagnostic Clinic PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

E8262 Issued in TX

Legal business name

FORT WORTH DIAGNOSTIC CLINIC PA

Practice address

1650 W Rosedale St Ste 100
Fort Worth, TX 76104-7400

Phone

(817) 338-1131

Fax

(817) 877-1511

NPI assigned

Aug 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul Jay Goldman, M.D.NPI 1053430975

Title

Physician

Phone

(817) 338-1131

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Fort Worth Diagnostic Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Paul J. Goldman,MD Diagnostic Clinic

  • Internal Medicine Physician
  • Granbury, TX
  • NPI 1376792390
  NPD tax ID

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10436/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Jay Goldman, M.D.

  • Emergency Medicine Physician
  • Fort Worth, TX
  • NPI 1053430975

  Specialist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1669665774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 W ROSEDALE ST STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047400",
            "telephone_number": "817-338-1131",
            "fax_number": "817-877-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W ROSEDALE ST STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047400",
            "telephone_number": "817-338-1131",
            "fax_number": "817-877-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH DIAGNOSTIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "817-338-1131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "E8262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083588601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.