NPIMap

Organization Active NPI

Invicta Healthcare PLLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Fort Worth, TX
National Provider Identifier
1740635143
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X
License
Q1450 Issued in TX
Legal business name
INVICTA HEALTHCARE PLLC
Practice address
9545 N Beach St Ste 101
Fort Worth, TX 76244-6470
Phone
(817) 381-9650
Fax
(817) 585-5836
NPI assigned
May 4, 2016
Last updated
Feb 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Authorized official

Name
Dr. Shiny Mary Abraham, MDNPI 1740456144
Title
Ceo
Phone
(216) 469-5575

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) Physician 207RA0401X Q1450 TX
Psychiatry Physician 2084P0800X Q0601 TX
Psychiatry Physician 2084P0800X Q1450 TX
Pain Medicine (Psychiatry & Neurology) Physician 2084P2900X Q1450 TX Primary
Pain Medicine Physician 208VP0000X

Addresses

Primary practice location

9545 N Beach St Ste 101
Fort Worth, TX 76244-6470

Mailing address

771 E Southlake Blvd Ste 101
Southlake, TX 76092-1483
Phone (216) 469-5516

Other practice location 1

771 E Southlake Blvd Ste 101
Southlake, TX 76092-1483
Phone (817) 381-9650

Other practice location 2

1011 Roberts Cutoff Rd
River Oaks, TX 76114-2814
Phone (817) 381-9650

Other practice location 3

2008 E Hebron Pkwy Ste 100
Carrollton, TX 75007-1601
Phone (817) 381-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190408000130 TX Part B Supplier - Clinic/Group Practice 5698016301 Receives reassigned benefits from 8 practitioners
Practice locations: Carrollton, TX; Fort Worth, TX; River Oaks, TX; Southlake, TX

National Provider Directory

National Provider Directory

Locations

9545 N Beach St
Ste 101
Fort Worth, TX 76244
Phone (817) 381-9650

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1740635143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 E SOUTHLAKE BLVD STE 101",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921483",
            "telephone_number": "216-469-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9545 N BEACH ST STE 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446470",
            "telephone_number": "817-381-9650",
            "fax_number": "817-585-5836"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "771 E Southlake Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Southlake",
            "state": "TX",
            "postal_code": "760921483",
            "country_code": "US",
            "telephone_number": "817-381-9650",
            "fax_number": "817-585-5836",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1011 Roberts Cutoff Rd",
            "address_purpose": "LOCATION",
            "city": "River Oaks",
            "state": "TX",
            "postal_code": "761142814",
            "country_code": "US",
            "telephone_number": "817-381-9650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2008 E Hebron Pkwy Ste 100",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "TX",
            "postal_code": "750071601",
            "country_code": "US",
            "telephone_number": "817-381-9650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INVICTA HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "SHINY",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "216-469-5575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "TX",
            "license": "Q1450",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q0601",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q1450",
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "TX",
            "license": "Q1450",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Feb 4, 2025; 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.