Kenneth Spencer Bode, MD
Individual provider Active NPI Orthopaedic Surgery of the Spine Physician · Fort Worth, TX
NPI 1710100045 · NPPES record last updated May 29, 2024
Key facts
- NPI
- 1710100045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery of the Spine Physician 207XS0117X
- License
- U1474 (TX)
- Practice address
- 6301 Harris Pkwy Ste 200
Fort Worth, TX 76132-4265 - Phone
- (817) 433-3450
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Green Oaks Physical Therapy Limited Partnership
Texas Health Physicians Group
Practice addresses (Care Compare)
350 Mercedes St
Benbrook, TX 76126-2593
Phone (817) 717-5390
6301 Harris Pkwy
Suite 200
Fort Worth, TX 76132-4265
Phone (817) 433-3450
Hospital & facility affiliations
- Enhabit Home Health
- Encompass Home Health of DFW
- Enhabit Home Health
- Texas Health Harris Methodist Hospital Southwest F
- Texas Health Harris Methodist Fort Worth
- Baylor Institute for Rehabilitation at Fort Worth
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 75 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Laminectomy or laminotomy (partial removal of spine bones) | 21 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230612000607 | TX | Practitioner - Orthopedic Surgery | 2668515230 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| U1474 | TX | MD | Orthopaedic Surgery of the Spine Physician |
| MD60635856 | WA | MD | Orthopaedic Surgery of the Spine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Health Physicians Group | Current |
Accepting new patients | |
| Texas Health Physicians Group | Current | Accepting new patients | |
| Adam Bruggeman MD PLLC | Orthopaedic Surgery | Current |
Accepting new patients |
| Adam Bruggeman MD PLLC | Orthopaedic Surgery of the Spine | Current |
Accepting new patients |
| Texas Health Physicians Group | Current |
Accepting new patients | |
| Northbay Physicians Surgery Center LLC | Past | Accepting new patients | |
| Norton Community Physician Services LLC | Orthopaedic Surgery | Past | Accepting new patients |
| Norton Community Physician Services LLC | Past | Accepting new patients |
Locations
1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803
6301 Harris Pkwy
Ste 200
Fort Worth, TX 76132
Phone (817) 433-3450
3619 Paesanos Pkwy
Ste 102
San Antonio, TX 78231
Phone (210) 399-4836
20770 US Highway 281 N
San Antonio, TX 78258
Phone (210) 366-9906
3619 Paesanos Pkwy
Ste 10
San Antonio, TX 78231
Phone (210) 399-4836
3619 Paesanos Pkwy
Ste 302
Shavano Park, TX 78231
Phone (210) 469-3830
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/UMZ-Uxn6V9x08sH5gCnG-5yPg9ZX7et6/
- kbode2499740@direct.texashealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | A122470 | CA | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | MD60635856 | WA | |
| Orthopaedic Surgery of the Spine Physician | 207XS0117X | U1474 | TX | Yes |
| Orthopaedic Surgery Physician | 207X00000X | U1474 | TX |
Addresses
Primary practice location
6301 Harris Pkwy Ste 200
Fort Worth, TX 76132-4265
Mailing address
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 916-5586
Other practice location 1
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (210) 916-5586
Other practice location 2
3619 Paesanos Pkwy Ste 302
San Antonio, TX 78231-1259
Phone (210) 802-4662
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| U1474 | Other | TX | STATE LICENSE |
| MD60635856 | Other | WA | STATE |
| A122470 | Other | CA | STATE LICENCE |
Other providers in Fort Worth, TX
- Kalan Nicole Bobbitt
- Sarah Bobbitt
- Abby Ann Bobo
- Berlyn Miller Bock
- Jared Bocks
- Ravi K Bodiwala
- Anne M Boeckmann
- Ashley Elizabeth Boehm
- Alexander K Boehme
- James H. Boehmler IV
All providers in Fort Worth, TX · Orthopaedic Surgery of the Spine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2024. 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.