NPIMap

Individual provider Active NPI

Nincy George Samuel, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1710352182
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10220 Issued in TX
Practice address
6451 Brentwood Stair Rd
#200
Fort Worth, TX 76112-3200
Phone
(817) 469-9700
Fax
(817) 469-9889
NPI assigned
Dec 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10220 TX Primary

Addresses

Primary practice location

6451 Brentwood Stair Rd
#200
Fort Worth, TX 76112-3200

Mailing address

1512 Ector Dr
Carrollton, TX 75010-6406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160212000779 TX Practitioner - Physician Assistant 2163726092 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55254CAMDDentist
PA10220TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Feb 14, 2022 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Feb 14, 2022 Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

1575 S Main St
Ft Worth, TX 76104
Phone (817) 702-8828

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1710352182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 ECTOR DR",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6451 BRENTWOOD STAIR RD",
            "address_2": "#200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123200",
            "telephone_number": "817-469-9700",
            "fax_number": "817-469-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "NINCY",
        "middle_name": "GEORGE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.