DEWITT CHARLES FORTENBERRY MD
NPI 1114960473
General Practice in Texarkana, TX
About Dewitt Charles Fortenberry Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DEWITT CHARLES FORTENBERRY MD (NPI 1114960473) is an individual general practice provider in Texarkana, Texas, licensed in Texas (L8691) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Willis Knighton Medical Center, and maintains a secondary practice location in Texarkana.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dewitt Charles Fortenberry Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Dewitt Fortenberry reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Texarkana, TX 75503
- Reassigned Medicare billing, Texas enrollment
- 3 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Willis Knighton Medical Center
Acute Care Hospitals · Shreveport, LASpecialists Hospital Shreveport
Acute Care Hospitals · Shreveport, LAChristus St Michael Health System
Acute Care Hospitals · Texarkana, TXMedicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Referred Medical Equipment & Supplies CMS DME claims 17
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 12
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TEXARKANA, TX 75503
TEXARKANA, TX 75503
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dewitt Fortenberry's NPI number?
The NPI number for Dewitt Fortenberry is 1114960473. It was assigned to this individual provider in the NPPES registry on June 14, 2006.
Where is Dewitt Fortenberry located?
Dewitt Fortenberry practices at 2602 Saint Michael Dr Suite 302, Texarkana, TX 75503. The listed phone number is (903) 336-2391.
What is Dewitt Fortenberry's specialty?
The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.
Is Dewitt Fortenberry enrolled in Medicare?
Yes. Dewitt Fortenberry is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Dewitt Fortenberry's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Dewitt Fortenberry reassigns Medicare benefits to Medeval, LLC (Texarkana, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dewitt Fortenberry's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Dewitt Fortenberry accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 6 other insurers list Dewitt Fortenberry as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Dewitt Fortenberry affiliated with any hospitals?
According to CMS data, Dewitt Fortenberry is affiliated with Willis Knighton Medical Center, Specialists Hospital Shreveport and Christus St Michael Health System.
When was this NPI record last updated?
The NPPES record for Dewitt Fortenberry was last updated on September 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dewitt Charles Fortenberry, MD · NPI 1114960473
General Practice physician in Texarkana, Texas. Individual provider, active in the CMS NPPES registry since June 14, 2006.
## Identity
- **NPI:** 1114960473 (Entity type: Individual)
- **Enumerated:** June 14, 2006
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **State license:** L8691 (Texas)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2602 SAINT MICHAEL DR, SUITE 302, Texarkana, TX 75503-2387
- **Phone:** (903) 336-2391
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Medeval, LLC (NPI 1740548346, Texarkana, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Johns Hopkins University School Of Medicine, class of 1990
## Record status
- **NPPES last updated:** September 17, 2023
- **Other identifiers:** Medicaid 167594401 (TX)
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Source: [NPI Profile](https://npiprofile.com/npi/1114960473) · Data from the CMS NPPES public registry.