Active NPI
Harry Fitch Klinefelter III, PHD
- Psychologist
- Fort Worth, TX
National Provider Identifier
1700887528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 22655
- Practice address
- 3509 Hulen St
BLDG 2 Ste 250
Fort Worth, TX 76107-6862 - Phone
- (817) 735-8245
- Fax
- (817) 735-4966
- NPI assigned
- Aug 2, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 22655 | TX | Primary |
Addresses
Primary practice location
3509 Hulen St
BLDG 2 Ste 250
Fort Worth, TX 76107-6862
Mailing address
3509 Hulen St
BLDG 2 Ste 250
Fort Worth, TX 76107-6862
Phone (817) 735-8245
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00F14C | Other | TX | BC BS TX |
| P00F14C8 | Medicaid | TX |
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120517000542 | TX | Practitioner - Clinical Psychologist | 4789847377 | Practice locations: Fort Worth, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3509 Hulen St
Fort Worth, TX 76107-6867
Phone (817) 735-8245
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213833600000",
"number": "1700887528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3509 HULEN ST",
"address_2": "BLDG 2 STE 250",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761076862",
"telephone_number": "817-735-8245",
"fax_number": "817-735-4966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3509 HULEN ST",
"address_2": "BLDG 2 STE 250",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761076862",
"telephone_number": "817-735-8245",
"fax_number": "817-735-4966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLINEFELTER",
"first_name": "HARRY",
"middle_name": "FITCH",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-02",
"last_updated": "2008-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "22655",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS TX",
"identifier": "00F14C",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P00F14C8",
"state": "TX"
}
],
"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 Jun 19, 2008; 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.