Way Out West Spine and Mobility PLLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

WAY OUT WEST SPINE AND MOBILITY PLLC

Practice address

120 Saint Louis Ave Ste 100
Fort Worth, TX 76104-1256

Phone

(682) 285-1044

Fax

(855) 361-0894

NPI assigned

Mar 14, 2019

Organization subpart

No

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

Authorized official

Name

Mike Martinez II, DONPI 1043534662

Title

Lead Physician

Phone

(682) 285-1044

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19180/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Mike Martinez II, D.O.

  • Interventional Pain Medicine Physician
  • Fort Worth, TX
  • NPI 1043534662
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1942769476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 SAINT LOUIS AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041256",
            "telephone_number": "682-285-1044",
            "fax_number": "855-361-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SAINT LOUIS AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041256",
            "telephone_number": "682-285-1044",
            "fax_number": "855-361-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAY OUT WEST SPINE AND MOBILITY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-14",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "LEAD PHYSICIAN",
        "authorized_official_telephone_number": "682-285-1044",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Watterson
• Barry K Watts, MD
• David C Watts, MD
• Jamie Watts, AUDIOLOGIST
• Samantha Marie Watts, PA-C
• Ali Raza Wazir, DO
• WCB Medical Center LLC
• WCHS of Texas
• We Are Star Specimen Collectors, LLC
• Eric Scott Wear, DDS

• Pain Medicine (Anesthesiology) Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pain Medicine (Anesthesiology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; 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.