Ian Underwood

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

5204 Emmeryville LN
Fort Worth, TX 76244-6200

Phone

(682) 351-4040

NPI assigned

Feb 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1770115099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5204 EMMERYVILLE LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5204 EMMERYVILLE LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446200",
            "telephone_number": "682-351-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "IAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Keller",
            "affiliation": "N",
            "address_1": "5204 Emmeryville Ln",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "762446200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Unbreakable Queer Counseling PLLC
• Unbroken Physical Therapy and Performance, LLC
• Under the Oaks Counseling, PLLC
• Jamie Marie Underhill, NP
• Frances Christina Underwood, M.S. CCC-SLP
• Unec Group Inc
• Alan M Unell, M.D.
• Hannah Leigh Unger, LMSW
• Jeremy Michael Unger, D.D.S.
• Unified Laboratory Services LLC

• Student in an Organized Health Care Education/Training Program in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.