Timothy James Immonen, D.O.

Primary specialty

Maternal & Fetal Medicine PhysicianTaxonomy code 207VM0101X

License

5101027095 Issued in MI

Practice address

1500 S Main St
Fort Worth, TX 76104-4917

Phone

(817) 702-1100

Fax

(817) 702-2140

NPI assigned

Apr 27, 2017

Last updated

Apr 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Obstetrics/Gynecology

Education

Edward Via Col of Osteo Medicine-Virginia Campus, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• JPS Health Network Hospital, Fort Worth, TX, CCN 450039

Merit-based Incentive Payment System (MIPS)

Final score

96.38 of 100Reported as group

Quality

80.41

Promoting interoperability

100

Improvement activities

40

Cost

78.69

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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

• Acclaim Physician Group, Inc

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1780076562
  Medicare reassignment Care Compare group
• Hni Medical Services of Ohio, LLC

  • Internal Medicine Physician
  • Middleburg Heights, OH
  • NPI 1356815922
  Medicare reassignment NPD
• Mercy Health Physicians Lorain Specialty Care LLC

  • Surgery Physician
  • Lorain, OH
  • NPI 1972126381
  Medicare reassignment NPD
• Mercy Health Physicians Lorain Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Vermilion, OH
  • NPI 1255063145
  NPD
• Tarrant County Hospital District

  dba JPS Health Network

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tarrant County Hospital District

  dba JPS Health Network

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  Care Compare affiliation

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1730614793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732973",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753736901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044917",
            "telephone_number": "817-702-1100",
            "fax_number": "817-702-2140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "535 NW 9th St",
            "address_2": "#220",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731021070",
            "country_code": "US",
            "telephone_number": "405-272-8498",
            "fax_number": "405-272-8425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMMONEN",
        "first_name": "TIMOTHY",
        "middle_name": "JAMES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34.015859",
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "MI",
            "license": "5101027095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maternal & Fetal Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Maternal & Fetal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.

Verify at the official NPI Registry.