NPIMap

Organization Active NPI

Fort Worth Pediatrics, P.a.

  • Pediatric Adolescent Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1972623031
Registry record updated Jun 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
FORT WORTH PEDIATRICS, P.A.
Practice address
1108 S Henderson St
Fort Worth, TX 76104-4430
Phone
(817) 335-3255
Fax
(817) 336-6780
NPI assigned
Mar 30, 2007
Last updated
Jun 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2011

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

Authorized official

Name
Diane Richey
Title
Administrator
Phone
(817) 336-4040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X TX Primary

Addresses

Primary practice location

1108 S Henderson St
Fort Worth, TX 76104-4430

Mailing address

5708 Edwards Ranch Road
Fort Worth, TX 76109
Phone (817) 336-4040

Other identifiers 4

IdentifierTypeStateIssuer
00L72LOtherTXBCBS
130900702MedicaidTX
10001409OtherTXAMERIGROUP
130900703OtherTXMEDICAID EPSDT

National Provider Directory

National Provider Directory
Tax ID family
Fort Worth Pediatrics6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308009600000",
    "number": "1972623031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5708 EDWARDS RANCH ROAD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76109",
            "telephone_number": "817-336-4040",
            "fax_number": "817-336-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 S HENDERSON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044430",
            "telephone_number": "817-335-3255",
            "fax_number": "817-336-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WORTH PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2011-06-14",
        "status": "A",
        "authorized_official_last_name": "RICHEY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-336-4040"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00L72L",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130900702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10001409",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID EPSDT",
            "identifier": "130900703",
            "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 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.