NPIMap

Organization Active NPI

Fort Worth Heart, P.a.

  • Medical Specialty Clinic/Center
  • Fort Worth, TX
National Provider Identifier
1801939244
Registry record updated Jun 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
FORT WORTH HEART, P.A.
Practice address
1900 Mistletoe Blvd
Suite 100
Fort Worth, TX 76104-4014
Phone
(817) 338-1300
NPI assigned
Feb 15, 2007
Last updated
Jun 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2017

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

Authorized official

Name
Mandi Womack
Title
Administration MNGR
Phone
(817) 338-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

1900 Mistletoe Blvd
Suite 100
Fort Worth, TX 76104-4014

Mailing address

1900 Mistletoe Blvd
Suite 100
Fort Worth, TX 76104-4014
Phone (817) 338-1300

Other identifiers 2

IdentifierTypeStateIssuer
CP2325OtherTXMEDICARE RAILROAD GROUP
084424301MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040607001334 TX Part B Supplier - Clinic/Group Practice 4082696562 Receives reassigned benefits from 44 practitioners
Practice locations: Burleson, TX; Cleburne, TX; Comanche, TX; Fort Worth, TX; Graham, TX; Granbury, TX; Weatherford, TX

National Provider Directory

National Provider Directory

Locations

4601 Boat Club Rd
Ste 125
Fort Worth, TX 76135

6100 Harris Pkwy
Ste 1230
Fort Worth, TX 76132

805 Hill Blvd
Ste 6
Granbury, TX 76048

2107 Fort Worth Hwy
Weatherford, TX 76086
Phone (817) 599-6954

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496620800000",
    "number": "1801939244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044014",
            "telephone_number": "817-338-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MISTLETOE BLVD",
            "address_2": "SUITE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044014",
            "telephone_number": "817-338-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH HEART, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2017-06-05",
        "status": "A",
        "authorized_official_last_name": "WOMACK",
        "authorized_official_first_name": "MANDI",
        "authorized_official_title_or_position": "ADMINISTRATION MNGR",
        "authorized_official_telephone_number": "817-338-1300"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP",
            "identifier": "CP2325",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084424301",
            "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 Jun 5, 2017; 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.