NPIMap

Organization Active NPI

Navjot Bajwa MD PA

Doing business as Children Medicaid Clinic

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1881913028
Registry record updated Sep 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K5790 Issued in TX
Legal business name
NAVJOT BAJWA MD PA
Doing business as
Children Medicaid Clinic
Practice address
11751 Alta Vista Rd
Suite 103
Fort Worth, TX 76244-6407
Phone
(817) 623-2012
Fax
(817) 623-2009
NPI assigned
May 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2014

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

Authorized official

Name
Navjot Bajwa, M.D.NPI 1487604567
Title
Provider
Phone
(817) 623-2012

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X K5790 TX Primary

Addresses

Primary practice location

11751 Alta Vista Rd
Suite 103
Fort Worth, TX 76244-6407

Mailing address

11751 Alta Vista Rd
Suite 103
Fort Worth, TX 76244-6407
Phone (817) 623-2012

Other identifiers 2

IdentifierTypeStateIssuer
281353701MedicaidTX
281353702OtherMEDICAID EP1

Other names 1

  • Children Medicaid Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110513000550 TX Part B Supplier - Clinic/Group Practice 5698951309 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory
Tax ID family
Children Medicaid Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11751 Alta Vista Rd
Ste 103
Fort Worth, TX 76244
Phone (817) 623-2012

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409788800000",
    "number": "1881913028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11751 ALTA VISTA RD",
            "address_2": "SUITE 103",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446407",
            "telephone_number": "817-623-2012",
            "fax_number": "817-623-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11751 ALTA VISTA RD",
            "address_2": "SUITE 103",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446407",
            "telephone_number": "817-623-2012",
            "fax_number": "817-623-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAVJOT BAJWA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2014-09-04",
        "status": "A",
        "authorized_official_last_name": "BAJWA",
        "authorized_official_first_name": "NAVJOT",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "817-623-2012",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K5790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281353701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID EP1",
            "identifier": "281353702",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children Medicaid Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 4, 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.