NPIMap

Organization Active NPI

Ehab Yacoub MD PLLC

  • Psychiatry Physician
  • Fort Worth, TX
National Provider Identifier
1700685997
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EHAB YACOUB MD PLLC
Practice address
1751 River Run Ste 200
Fort Worth, TX 76107-6670
Phone
(877) 515-8113
NPI assigned
Mar 10, 2025
Last updated
Mar 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Dr. Ehab Yacoub, MDNPI 1295884088
Title
Ceo
Phone
(877) 515-8113

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1751 River Run Ste 200
Fort Worth, TX 76107-6670

Mailing address

PO Box 451249
Los Angeles, CA 90045-8513
Phone (877) 515-8113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250627001028 TX Part B Supplier - Clinic/Group Practice 1153834759 Receives reassigned benefits from 15 practitioners
Practice locations: Austin, TX; Fort Worth, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1741564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1700685997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 451249",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900458513",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 RIVER RUN STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076670",
            "telephone_number": "877-515-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EHAB YACOUB MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "YACOUB",
        "authorized_official_first_name": "EHAB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-515-8113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.