Individual provider Active NPI

Ann Catherine Teal, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1679561914
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
815 Pennsylvania Ave
Fort Worth, TX 76104-2294
Phone
(817) 321-0404
NPI assigned
Oct 11, 2005
Last updated
Jul 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Medical Physician Assistant 363AM0700X PA02558 TX

Addresses

Primary practice location

815 Pennsylvania Ave
Fort Worth, TX 76104-2294

Mailing address

816 W Cannon St
Fort Worth, TX 76104-3194
Phone (817) 321-0390

Other practice location 1

1300 W Terrell Ave
#500
Fort Worth, TX 76104-2800
Phone (817) 252-5000

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
I20040601000578 TX Practitioner - Physician Assistant 5799766176 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Clinical Care in RadiologyGroup PAC ID 8729429592, 15 clinicians

Practice addresses (Care Compare)

1500 S Main St
John Peter Smith
Fort Worth, TX 76104-4917
Phone (817) 321-0404

1622 8TH Ave
Suite 120
Fort Worth, TX 76104-4155
Phone (817) 321-0404

800 W Magnolia Ave
Fort Worth, TX 76104-4611

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA02558TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Heart Care of San Antonio CurrentSince Mar 14, 2017 Accepting new patients
Radiology Associates of North Texas PA CurrentSince Sep 15, 2022 Accepting new patients
Radiology Associates of North Texas PA CurrentSince Sep 15, 2022 Accepting new patients
J Brian Deville, MD PA Past Accepting new patients
Legacy Heart Care of Grand Prairie, LLC PastSince Jun 1, 2022 Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

1622 8th Ave
Ste 120
Fort Worth, TX 76104
Phone (817) 923-8220

2500 West Fwy
Ste 200
Ft Worth, TX 76102
Phone (817) 423-4400

6100 Harris Pkwy
Ft Worth, TX 76132
Phone (817) 346-5000

815 Pennsylvania Ave
Ft Worth, TX 76104
Phone (817) 321-0300

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

12702 Toepperwein Rd
Ste 123
Live Oak, TX 78233
Phone (210) 934-4100

3903 Wiseman Blvd
Ste 114
San Antonio, TX 78251
Phone (210) 256-9467

1814 Roseland Blvd
Ste 100
Tyler, TX 75701
Phone (214) 696-8033

Organizations & group practices 10

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 1

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": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1679561914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043194",
            "telephone_number": "817-321-0390",
            "fax_number": "817-321-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042294",
            "telephone_number": "817-321-0404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 W Terrell Ave",
            "address_2": "#500",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761042800",
            "country_code": "US",
            "telephone_number": "817-252-5000",
            "fax_number": "817-252-5060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEAL",
        "first_name": "ANN",
        "middle_name": "CATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA02558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.