Uyen Ngoc Bao Phan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2800 E Broad St
Suite 124
Mansfield, TX 76063-6409

Phone

(817) 539-0959

Fax

(817) 539-0480

NPI assigned

Jul 21, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mansfield Dermatology, PLLCGroup PAC ID 2769545458, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mansfield Dermatology, PLLC

  • Dermatology Physician
  • Mansfield, TX
  • NPI 1598913253
  Medicare reassignment Care Compare group
• United Dermatology Associates of Euless PLLC

  • Dermatology Physician
  • Euless, TX
  • NPI 1528829025
  Medicare reassignment NPD
• United Dermatology Associates of Arlington, PLLC

  • Dermatology Physician
  • Arlington, TX
  • NPI 1386228930
  Medicare reassignment NPD (past)
• United Dermatology Associates of Burleson, PLLC

  • Dermatology Physician
  • Burleson, TX
  • NPI 1457778474
  Medicare reassignment
• United Dermatology Associates of Flower Mound, PLLC

  • Dermatology Physician
  • Flower Mound, TX
  • NPI 1649602954
  Medicare reassignment

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

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1669857595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 N FIELDER RD",
            "address_2": "SUITE C",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760124697",
            "telephone_number": "817-261-1122",
            "fax_number": "817-261-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E BROAD ST",
            "address_2": "SUITE 124",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760636409",
            "telephone_number": "817-539-0959",
            "fax_number": "817-539-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "UYEN",
        "middle_name": "NGOC BAO",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-21",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mai Pham, DPM
• Phuong Pham, OD
• Johnny Phan, O.D.
• Linda K Phan, MD
• Phi Thuong Phan, PHARM D
• Pharmatise
• Jacqueline Phelps
• Minu Bijo Philip, PMHNP-BC
• Alexa D Philipose, PA
• Monica Leigh Phillips, FNP

• Physician Assistant in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.