Individual provider Active NPI

Fatima Y Douglas, FNP

  • Family Nurse Practitioner
  • Beaumont, TX
National Provider Identifier
1821799594
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1110415 Issued in TX
Practice address
755 N 11TH St Ste P2200
Beaumont, TX 77702-1513
Phone
(409) 892-1192
NPI assigned
Mar 10, 2023
Last updated
May 14, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1110415 TX Primary

Addresses

Primary practice location

755 N 11TH St Ste P2200
Beaumont, TX 77702-1513

Mailing address

755 N 11TH St Ste P2200
Beaumont, TX 77702-1513

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230503003615 TX Practitioner - Nurse Practitioner 9436514007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Cardiovascular Specialists LLPGroup PAC ID 9032179791, 12 clinicians

Practice addresses (Care Compare)

755 N 11TH St
Suite P2200
Beaumont, TX 77702-1513
Phone (409) 892-1192

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.52 of 100Reported as group
Quality
85.38
Improvement activities
40
Cost
82.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1110415TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Cardiovascular Specialists, LLP CurrentSince Apr 3, 2023 Accepting new patients
Neches Clinic PLLC CurrentSince Apr 3, 2023 Accepting new patients

Locations

755 N 11th St
Ste P2200
Beaumont, TX 77702
Phone (409) 892-1192

2014 S Wheeler St
Ste 200
Jasper, TX 75951
Phone (409) 383-1780

Interoperability endpoints

  • Direct secure messaging: fatima.douglas.p4@direct.ahgcardiology.nextgenshare.com
  • FHIR API: https://api.platform.athenahealth.com/22304/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1821799594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 N 11TH ST STE P2200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 N 11TH ST STE P2200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021513",
            "telephone_number": "409-892-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "FATIMA",
        "middle_name": "Y",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-10",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1110415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.