| Carelon Medical Partners Of Arizona, P.c. | |
|
512 W Rosedale St Fort Worth TX 76104-4619 | |
| (817) 289-8300 | |
| (817) 289-8263 |
| Full Name | Carelon Medical Partners Of Arizona, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 512 W Rosedale St, Fort Worth, Texas |
| Authorized Official Name and Position | Timothy Ablion (OWNER) |
| Authorized Official Contact | 2242345025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carelon Medical Partners Of Arizona, P.c. 12900 Park Plaza Dr Cerritos CA 90703-9329 Ph: (562) 622-2950 | Carelon Medical Partners Of Arizona, P.c. 512 W Rosedale St Fort Worth TX 76104-4619 Ph: (817) 289-8300 |
| NPI Number | 1730697483 |
|---|---|
| Provider Enumeration Date | 01/16/2018 |
| Last Update Date | 06/27/2024 |
| Certification Date | 06/27/2024 |
| Medicare PECOS PAC ID | 6406010552 |
|---|---|
| Medicare Enrollment ID | O20181120000064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730697483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (District Of Columbia) | Primary |
| Provider Name | Nyota M Pieh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760703466 PECOS PAC ID: 9638390040 Enrollment ID: I20161005002956 |
| Provider Name | Tsion Gebresellasie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134668155 PECOS PAC ID: 2860768827 Enrollment ID: I20171019001799 |
| Provider Name | Nancy Singer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891282448 PECOS PAC ID: 4981958329 Enrollment ID: I20181121000652 |
| Provider Name | Aelaf Worku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659537066 PECOS PAC ID: 3476703869 Enrollment ID: I20181203000224 |
| Provider Name | Afua Ofosuhene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578091880 PECOS PAC ID: 3072947415 Enrollment ID: I20191218001469 |
| Provider Name | Liliana Martin Del Campo Lustig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407372022 PECOS PAC ID: 4688030075 Enrollment ID: I20230509001608 |
| Provider Name | William Logan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588603682 PECOS PAC ID: 5092616755 Enrollment ID: I20230623000096 |
| Provider Name | Danielle Fernald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033622493 PECOS PAC ID: 0648536037 Enrollment ID: I20240425001075 |
| Provider Name | Corrine Favela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447304001 PECOS PAC ID: 3971881889 Enrollment ID: I20240510003382 |
| Provider Name | Jesse Korth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457870586 PECOS PAC ID: 4587091350 Enrollment ID: I20240521000173 |
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