1. Home
  2. Directory
  3. Texas
  4. Fort Worth
  5. Family Medicine
  6. NPI Profile

CHANIDA K SUPAVONG DO
NPI 1750672218
Family Medicine in Fort Worth, TX

Active since May 02, 2011PECOS Enrolled
5450 CLEARFORK MAIN ST STE 460, FORT WORTH, TX 76109(817) 423-5121(817) 423-5122 Get Directions Write a Review

NPPES record last updated: July 25, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Chanida K Supavong Do NPPES

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

CHANIDA K SUPAVONG DO (NPI 1750672218) is an individual family medicine provider in Fort Worth, Texas, licensed in Texas (P5896) and active in the NPI registry since May 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1750672218
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameCHANIDA K SUPAVONGCredential: DO
Location Address5450 CLEARFORK MAIN ST STE 460Fort Worth, TX 76109
Mailing Address5450 Clearfork Main St Ste 460Fort Worth, TX 76109-3560 · (817) 423-5121 · Fax (817) 423-5122
Phone(817) 423-5121
Fax(817) 423-5122
Sole ProprietorNo
Enumeration DateMay 2, 2011
Last NPPES UpdateJuly 25, 2018
✔ NPI 1750672218 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in TX · P5896
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.
5450 CLEARFORK MAIN ST STE 460, Fort Worth, TX 76109
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Chanida K Supavong Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76109 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.20 typical visit price
range $56.47 – $171.07
Typical copayment $21.80 (range $14.11 – $42.76)
Most-billed visit code 99203
Established Patient
$99.68 typical visit price
range $18.18 – $139.68
Typical copayment $24.92 (range $4.54 – $34.92)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTIN GARNER FREEMAN M.D.
Family Medicine
5450 CLEARFORK MAIN ST STE 460
FORT WORTH, TX 76109
Tarrant County (817) 423-5121

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 Chanida Supavong's NPI number?

The NPI number for Chanida Supavong is 1750672218. It was assigned to this individual provider in the NPPES registry on May 2, 2011.

Where is Chanida Supavong located?

Chanida Supavong practices at 5450 Clearfork Main St Ste 460, Fort Worth, TX 76109. The listed phone number is (817) 423-5121.

What is Chanida Supavong's specialty?

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

Is Chanida Supavong enrolled in Medicare?

Yes. Chanida Supavong is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Chanida Supavong was last updated on July 25, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.