OrganizationActive
Foundation Iom LLC
NPI 1639872088 · Electrodiagnostic Medicine Physician · Ft Worth, TX
Provider details
- NPI number
- 1639872088
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gina Sullivan, Practice Administrator(903) 259-0550
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Phone: (817) 529-8488
Fax: (903) 328-6568
Street-level locationGet directions
Mailing address
111 Boland St Ste 211
Ft Worth, TX 76107-1265
Registry dates
- Enumerated
- 2023-03-24
- Last updated
- 2023-03-24
- Certified
- 2023-03-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.