FORT WORTH LUNG CLINIC, PA – Primary Care Clinic/Center, NPI 1558655274

FORT WORTH LUNG CLINIC, PA is a healthcare provider. based in Fort worth, Texas. specializing in Primary Care Clinic/Center. The organization holds a License No. N0617 (TX). The NPI Number for FORT WORTH LUNG CLINIC, PA is 1558655274

Main info

Organization
Name
FORT WORTH LUNG CLINIC, PA
NPI
1558655274
Phone
(817) 336-8773
Address
800 8th Ave Ste 412
Authorized Official
DEREJE SAHEL AYO PRESIDENT MD
Enumeration Date
31 May 2011
Last Update Date
19 February 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:15State licenses:1Digital endpointsOther names

Provider Addresses for FORT WORTH LUNG CLINIC, PA

  • 800 8th Ave Ste 412

    Fort Worth, TX 761042618

    Phone: (817) 336-8773

    Fax: (817) 338-1063

    Type: Location

  • 8036 OCEAN DR

    FORT WORTH, TX 761231895

    Phone: (817) 739-1080

    Fax: (817) 370-7942

    Type: Location

  • 11803 SOUTH FWY STE 136

    BURLESON, TX 760288460

    Phone: (817) 568-8411

    Fax: (817) 568-8414

    Type: Location

  • PO BOX 16284

    FORT WORTH, TX 761620284

    Phone: (817) 739-1080

    Fax: (817) 370-7942

    Type: Mailing

  • 11803 SOUTH FWY STE 311

    BURLESON, TX 760287036

    Phone: (817) 568-8411

    Fax: (817) 568-8414

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2011-09-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2025-10-31 (223 days ago).

Enrollment records

1

Earliest due date

2025-10-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20110923000606OClinic/Group PracticeTX2025-10-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76104)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for FORT WORTH LUNG CLINIC, PA?
FORT WORTH LUNG CLINIC, PA — NPI 1558655274 — is the standard way to identify this listing.
Does the file indicate FORT WORTH LUNG CLINIC, PA is practicing under active NPI?
Directory data currently reports FORT WORTH LUNG CLINIC, PA as active.
What healthcare role does FORT WORTH LUNG CLINIC, PA hold?
Scheduling teams often label FORT WORTH LUNG CLINIC, PA under Primary Care Clinic/Center. Clinical services aligned with this taxonomy classification.
Does FORT WORTH LUNG CLINIC, PA list a practice location?
Patients near Fort Worth, Texas may find FORT WORTH LUNG CLINIC, PA in results; validate coverage separately.
Why does FORT WORTH LUNG CLINIC, PA have multiple addresses?
5 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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