Stephanie Marie Gomez, LCSW
Individual provider Active NPI Clinical Social Worker · Fort Worth, TX
NPI 1699071969 · NPPES record last updated Aug 16, 2011
Key facts
- NPI
- 1699071969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 32319 (TX)
- Practice address
- 3345 Western Center Blvd Ste 140
Fort Worth, TX 76137-1938 - Phone
- (817) 269-7060
- Fax
- (817) 636-2704
- NPI assigned
- Feb 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Assurasource LTD
Practice addresses (Care Compare)
400 N Allen Dr
Suite 204
Allen, TX 75013-2568
Phone (972) 233-1010
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110317000871 | TX | Practitioner - Clinical Social Worker | 1456534197 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Assurasource LTD | Clinical | Current |
Accepting new patients |
Locations
400 N Allen Dr
Ste 204
Allen, TX 75013
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 32319 | TX | Yes |
Addresses
Primary practice location
3345 Western Center Blvd Ste 140
Fort Worth, TX 76137-1938
Mailing address
805 Conestoga TRL
Rhome, TX 76078-4216
Phone (817) 269-7060
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TXB119241 | Other | TX | MEDICARE PTAN |
Other providers in Fort Worth, TX
- Emi Gomez
- Erica Michelle Gomez
- Hayley Michelle Gomez
- Kelly Gomez
- Kirsten A Gomez
- Anjaunette Denise Gonder
- Grace K Gongidi
- Preetam Gongidi
- Jessica A Gonzales-Latchaw
- Amanda Danette Gonzales
All providers in Fort Worth, TX · Clinical Social Worker in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.