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FOSSIL CREEK FAMILY MEDICAL CENTER
NPI 1639267982
Family Medicine in Fort Worth, TX

Active since October 11, 2006CLIA 45D0686536 · Microscopy
7510 N BEACH ST, FORT WORTH, TX 76137(817) 498-1818(817) 581-3761 Get Directions Write a Review

NPPES record last updated: March 15, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 15, 2019, Jul 31, 2018 (2 updates tracked since 2018).

About Fossil Creek Family Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOSSIL CREEK FAMILY MEDICAL CENTER (NPI 1639267982) is a healthcare organization registered as a family medicine in Fort Worth, Texas and active in the NPI registry since October 2006. The organization holds a CLIA Microscopy certificate valid through July 6, 2027 and lists David Wayne Simonak, Owner, as its authorized official.

NPPES Registry Identity

NPI1639267982
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameFOSSIL CREEK FAMILY MEDICAL CENTER
Location Address7510 N BEACH STFort Worth, TX 76137
Mailing Address7500 N Beach StFort Worth, TX 76137-1505 · (817) 498-1818 · Fax (817) 581-3761
Phone(817) 498-1818
Fax(817) 581-3761
Organization SubpartNo
Authorized OfficialDavid Wayne SimonakOwner · (817) 498-1818
Enumeration DateOctober 11, 2006
Last NPPES UpdateMarch 15, 20192 updates tracked since enumeration
✔ NPI 1639267982 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
7510 N BEACH ST, Fort Worth, TX 76137
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Other Identifiers 1

Medicaid121142701TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Fossil Creek Family Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Fossil Creek Family Medical Center, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Brady Simonak, D.O.
Family Practice
NPI 1821418658
7510 N BEACH ST
Fort Worth, TX 76137
(817) 498-1818
✔ PECOS✔ Accepts MedicareSame address
Ryan Simonak, D.O.
Family Practice
NPI 1871721993
7510 N BEACH ST
Fort Worth, TX 76137
(817) 498-1818
✔ PECOS✔ Accepts MedicareSame address
David Simonak, D.O.
Family Practice
NPI 1093735151
7500 N BEACH ST
Fort Worth, TX 76137
(817) 498-1818
✔ PECOS✔ Accepts Medicare0.1 mi
Timothy Hawley
Nurse Practitioner
NPI 1720458896
8849 DAVIS BLVD STE 300
Keller, TX 76248
(817) 358-3552
✔ PECOS✔ Accepts Medicare6.8 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D0686536

Fossil Creek Family Medical Center · Fort Worth, TX
Active · expires Jul 6, 2027
CLIA Number45D0686536
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2025
Certificate Expiration DateJuly 6, 2027
Laboratory DirectorDavid W. Simonak
Laboratory Phone(817) 498-1818
Laboratory LocationFossil Creek Family Medical Center7510 North Beach Street, Fort Worth, TX 76137
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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 Fossil Creek Family Medical Center's NPI number?

The NPI number for Fossil Creek Family Medical Center is 1639267982. It was assigned to this organization in the NPPES registry on October 11, 2006.

Where is Fossil Creek Family Medical Center located?

Fossil Creek Family Medical Center is located at 7510 N Beach St, Fort Worth, TX 76137. The listed phone number is (817) 498-1818.

What is Fossil Creek Family Medical Center's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Fossil Creek Family Medical Center enrolled in Medicare?

Yes. Fossil Creek Family Medical Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Fossil Creek Family Medical Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Fossil Creek Family Medical Center. A 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 the clinician's services. The largest specialties are Family Practice (3) and Nurse Practitioner (1). Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Fossil Creek Family Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D0686536) is associated with this NPI, valid through July 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fossil Creek Family Medical Center was last updated on March 15, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.