Individual provider Active NPI

Alex Fitzhugh

  • Endodontics
  • Burleson, TX
National Provider Identifier
1891220596
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
32866 Issued in TX
Practice address
101 NW Renfro St Ste 102
Burleson, TX 76028-4178
Phone
(817) 295-1444
NPI assigned
May 1, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4039 AR
Endodontics 1223E0200X 32866 TX Primary

Addresses

Primary practice location

101 NW Renfro St Ste 102
Burleson, TX 76028-4178

Mailing address

4224 Shannon Dr
Fort Worth, TX 76116-8044

Other practice location 1

10110 Stephens Ct
Fort Smith, AR 72908-9339
Phone (479) 353-2415

Other practice location 2

4224 Shannon Dr
Fort Worth, TX 76116-8044
Phone (479) 353-2415

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180208000310 TX Order and Referring Only - DentistPractitioner - Dentist 1254691439

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4039ARMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1493596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1891220596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4224 SHANNON DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761168044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NW RENFRO ST STE 102",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760284178",
            "telephone_number": "817-295-1444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10110 Stephens Ct",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729089339",
            "country_code": "US",
            "telephone_number": "479-353-2415",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4224 Shannon Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761168044",
            "country_code": "US",
            "telephone_number": "479-353-2415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITZHUGH",
        "first_name": "ALEX",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-01",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4039",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "32866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burleson, TX

Sources for this page

Verify at the official NPI Registry.