NPIMap

Organization Active NPI

Fort Worth Brain & Spine Institute, LLP

  • Neurological Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1770503237
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
61650301 Issued in TX
Legal business name
FORT WORTH BRAIN & SPINE INSTITUTE, LLP
Practice address
1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4014
Phone
(817) 878-5333
Fax
(817) 878-5334
NPI assigned
Jul 20, 2006
Last updated
Apr 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

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

Authorized official

Name
Thomas S Ellis, MDNPI 1629004445
Title
President
Phone
(817) 878-5333

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 61650301 TX Primary

Addresses

Primary practice location

1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4014

Mailing address

1900 Mistletoe Blvd
Suite 200
Fort Worth, TX 76104-4014
Phone (817) 878-5333

Other identifiers 2

IdentifierTypeStateIssuer
158682801OtherTXTPI
DA1062OtherTXRAILROAD MEDICARE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040610001218 TX Part B Supplier - Clinic/Group Practice 0840273868 Receives reassigned benefits from 23 practitioners
Practice locations: Granbury, TX; Weatherford, TX; Fort Worth, TX; Cleburne, TX
O20111020000430 TX DME Supplier - Physician - Neurosurgery 0840273868 Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

2035 Fort Worth Hwy
Ste 100
Weatherford, TX 76086
Phone (817) 594-0496

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1770503237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "address_2": "SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044014",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "address_2": "SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044014",
            "telephone_number": "817-878-5333",
            "fax_number": "817-878-5334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH BRAIN & SPINE INSTITUTE, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-878-5333",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "61650301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TPI",
            "identifier": "158682801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA1062",
            "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 Apr 21, 2014; 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.