NPIMap

Organization Active NPI

Clearcut Ortho, LLC

  • Physical Therapist
  • Fort Worth, TX
National Provider Identifier
1720565583
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CLEARCUT ORTHO, LLC
Practice address
1001 12TH Ave Ste 201
Fort Worth, TX 76104
Phone
(817) 719-7714
Fax
(817) 796-1114
NPI assigned
Jul 24, 2018
Last updated
Sep 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Authorized official

Name
Kenneth Wheeler, DPT, OCS, NCSNPI 1427492941
Title
Owner/Physical Therapist
Phone
(817) 719-7714

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Clinical Electrophysiology Physical Therapist 2251E1300X NU
Neurology Physical Therapist 2251N0400X NU
Orthopedic Physical Therapist 2251X0800X NU

Addresses

Primary practice location

1001 12TH Ave Ste 201
Fort Worth, TX 76104

Mailing address

1001 12TH Ave Ste 201
Fort Worth, TX 76104-3926
Phone (817) 719-7714

Other identifiers 1

IdentifierTypeStateIssuer
394270802MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181015001060 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365794609 Receives reassigned benefits from 13 practitioners
Practice locations: Fort Worth, TX
O20200810002703 TX DME Supplier - Independently-Practicing Physical Therapist 2365794609 Practice locations: Ft Worth, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1720565583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE STE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "817-719-7714",
            "fax_number": "817-796-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE STE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-719-7714",
            "fax_number": "817-796-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARCUT ORTHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "817-719-7714",
        "authorized_official_credential": "DPT, OCS, NCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "394270802",
            "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 Sep 16, 2022; 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.