USMD DIAGNOSTIC SERVICES, LLC (NPI# 1366977449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366977449 |
| Entity Type | Organization |
| Organization Name | USMD DIAGNOSTIC SERVICES, LLC |
| Other Organization Name | USMD IMAGING CENTER AT CLEARFORK |
| Practice Address |
5450 Clearfork Main St Suite 110 Fort Worth TX 76109-3559 |
| Practice Telephone | 8175050222 |
| Practice Fax Number | 8175103690 |
| Mailing Telephone | 8175050222 |
| Mailing Fax Number | 8175103690 |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |
| Authorized Official Name | DR. RICHARD COLEMAN JOHNSTON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2144934015 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | USMD HOLDINGS, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| Other Name | Type Code |
|---|---|
| USMD Imaging Center at Clearfork | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780940270 | Usmd Diagnostic Services, LLC | Clinical Medical Laboratory | 6333 North State Highway 161, Suite 200, Irving, TX 75038-4049 | 2012-04-09 |
| 1467766550 | Usmd Diagnostic Services, LLC | Clinic/Center | 900 Airport Freeway, Suite 132, Hurst, TX 76054-3252 | 2010-07-30 |
| 1730573312 | Usmd Diagnostic Services, LLC | Physiological Laboratory | 811 W. I-20, Suite G-26, Arlington, TX 76017-3252 | 2015-03-23 |
| 1235450743 | Usmd Diagnostic Services, LLC | Clinical Medical Laboratory | 1300 W Terrell Ave, Suite 404, Fort Worth, TX 76104-2820 | 2010-06-18 |
| Street Address |
5450 CLEARFORK MAIN ST SUITE 110 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76109-3559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568760981 | Prysca N Mbi | Family Medicine | 5450 Clearfork Main St, Ste 230, Fort Worth, TX 76109-3500 | 2011-03-09 |
| 1376991026 | Lauren Walden | Family Medicine | 5450 Clearfork Main St, Fort Worth, TX 76109-3559 | 2016-06-02 |
| 1093194912 | Samim Giotis | Family Medicine | 5450 Clearfork Main St, Fort Worth, TX 76109-3559 | 2015-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881156164 | Elizabeth Laborde Dds Pllc | Clinic/Center | 5656 Edwards Ranch Rd, Fort Worth, TX 76109 | 2019-04-04 |
| 1992273965 | Debra Cooper Lantz | Occupational Therapist | 4252 Bryant Irvin Road, Fort Worth, TX 76109 | 2018-11-08 |
| 1417434119 | Dermatology Specialists of Fort Worth Pllc | Dermatology | 6100 Southwest Blvd., Suite 100, Fort Worth, TX 76109 | 2018-07-25 |
| 1417446709 | Eating Recovery Center of Texas, LLC | Clinic/Center | 4200 S. Hulen Street, Suite #436, Ft. Worth, TX 76109 | 2018-05-02 |
| 1245751742 | Marissa Izabel San Miguel | Optometrist | 5912 Convair Dr Ste 208, Fort Worth, TX 76109 | 2017-07-05 |
| 1174910111 | Parkway Dental Professionals | Preferred Provider Organization | 4200 Bryant Irvin Rd. Ste. 101, Fort Worth, TX 76109 | 2015-04-16 |
| 1831583095 | Deborah K Lehmann, M.d. | Clinic/Center | 6420 Southwest Blvd., #128, Fort Worth, TX 76109 | 2015-03-26 |
| 1184036428 | Ft Worth Ranch Assist, LLC | Neurological Surgery | 3516 Ranch View Terrace, Fort Worth, TX 76109 | 2014-05-21 |
| 1821435538 | Metx LLC | Hearing Instrument Specialist | 4618 Sw Loop 820, Fort Worth, TX 76109 | 2013-06-04 |
| 1356608087 | Virginia Flores | Social Worker | 4208 Ranier Ct, Fort Worth, TX 76109 | 2012-04-19 |
| Find all providers in zip 76109 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194334144 | Sonji M Blanchard | Physiological Laboratory | 8553 N Beach St Ste 224, Fort Worth, TX 76244-4919 | 2020-07-27 |
| 1649753716 | Health Imaging Partners LLC | Physiological Laboratory | 5701 Bryant Irvin Rd Ste 101, Fort Worth, TX 76132-4052 | 2018-09-13 |
| 1104109552 | Health Imaging Partners, LLC | Physiological Laboratory | 2911 Oak Park Circle, Fort Worth, TX 76109 | 2011-09-22 |
| 1144411570 | Fort Worth I Enterprises, LLC Dba Healthy Images of Texas | Physiological Laboratory | 4150 International Plz Ste 600, Fort Worth, TX 76109-4831 | 2007-08-09 |
| 1518023274 | Kenneth Wayne Morris | Physiological Laboratory | 4707 Alwood Ct, Fort Worth, TX 76135-1901 | 2006-12-28 |
| 1679525695 | Star Diagnostics of Tarrant County | Physiological Laboratory | 2100 N Main St, Ll20, Fort Worth, TX 76106-8570 | 2006-05-17 |
| 1154379741 | Diagnostic Health Centers of Texas Limited Partnership | Physiological Laboratory | 6001 Harris Pkwy, Fort Worth, TX 76132-4103 | 2006-05-05 |
| 1932166105 | Maxum Health Services Corp | Physiological Laboratory | 1199 8th Ave, Fort Worth, TX 76104-4102 | 2006-04-28 |
| 1083006233 | Btdi Jv, LLP | Physiological Laboratory | 1263 W Rosedale St, Suite 105, Fort Worth, TX 76104-2801 | 2015-02-25 |
| 1104218775 | Btdi Jv, LLP | Physiological Laboratory | 1199 8th Ave, Fort Worth, TX 76104-4102 | 2015-02-19 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.