Individual provider Active NPI

Michael Charles Ampelas, DO

  • Family Medicine Physician
  • Fort Worth, TX
National Provider Identifier
1992753818
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L8265 Issued in TX
Practice address
900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8517
Phone
(817) 921-6166
Fax
(817) 921-9594
NPI assigned
May 4, 2006
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L8265 TX Primary

Addresses

Primary practice location

900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8517

Mailing address

900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8517
Phone (817) 921-6166

Other identifiers 1

IdentifierTypeStateIssuer
167450904MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mampelas225329@direct.sw.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040927001144 TX Practitioner - Family Practice 7810966835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1005 Legacy Ranch Rd
Suite 100
Waxahachie, TX 75165-1294
Phone (469) 800-9790

1101 6TH Ave
Suite 110
Fort Worth, TX 76104-4306
Phone (817) 912-8360

1110 Parker Square
Flower Mound, TX 75028-7432
Phone (972) 724-1707

1441 S Midlothian Pkwy
100 Baylor Scott and White
Midlothian, TX 76065-5591
Phone (469) 800-9600

4001 Worth St
Dallas, TX 75246-1608

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

821 N Coleman St
Suite 100
Prosper, TX 75078-2339
Phone (469) 800-5200

900 W Magnolia Ave
Suite 201
Fort Worth, TX 76104-8518
Phone (817) 921-6166

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
L8265TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Sep 1, 2005 Accepting new patients
Healthtexas Provider Network Family Medicine CurrentSince Sep 1, 2005 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients
Healthtexas Provider Network Family Medicine Past Accepting new patients
Glen Rose Medical Foundation Inc. Past Accepting new patients
Glen Rose Medical Foundation Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
Dallas, TX 75246
Phone (214) 828-1745

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

900 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 921-6166

821 N Coleman St
Ste 100
Prosper, TX 75078
Phone (469) 800-5200

Organizations & group practices 6

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 2

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1992753818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W MAGNOLIA AVE",
            "address_2": "SUITE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761048517",
            "telephone_number": "817-921-6166",
            "fax_number": "817-921-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W MAGNOLIA AVE",
            "address_2": "SUITE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761048517",
            "telephone_number": "817-921-6166",
            "fax_number": "817-921-9594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMPELAS",
        "first_name": "MICHAEL",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L8265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167450904",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mampelas225329@direct.sw.org",
            "affiliation": "N",
            "address_1": "900 W Magnolia Ave",
            "address_2": "Suite 201",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761048517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.