Renovar Wellcare PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

RENOVAR WELLCARE PLLC

Practice address

1509 W Hebron Pkwy Ste 140
Carrollton, TX 75010-6492

Phone

(972) 306-0016

Fax

(972) 306-0017

NPI assigned

May 10, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Olusesan Oluseun Olotu, MDNPI 1366882623

Title

Director

Phone

(972) 306-0016

Specialties & licenses 1

Addresses

Other names 1

• Essencia Family Practice and Immediate Care Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Olusesan Oluseun Olotu, M.D.

  • Family Medicine Physician
  • Carrollton, TX
  • NPI 1366882623
  Medicare reassignment NPD Authorized official
• Alice Ann Bagby, FNP

  • Family Nurse Practitioner
  • Ennis, TX
  • NPI 1972298842
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657411200000",
    "number": "1013407451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8533 ROYAL COUNTY DOWN DR",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750701680",
            "telephone_number": "972-306-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 W HEBRON PKWY STE 140",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750106492",
            "telephone_number": "972-306-0016",
            "fax_number": "972-306-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENOVAR WELLCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2022-07-10",
        "certification_date": "2022-07-10",
        "status": "A",
        "authorized_official_last_name": "OLOTU",
        "authorized_official_first_name": "OLUSESAN",
        "authorized_official_middle_name": "OLUSEUN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "972-306-0016",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essencia Family Practice and Immediate Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renal Center of Carrollton, LP, LLLP
• Renal Treatment Centers-Southeast, LP.
• Steven Christopher Renas, DMD
• Shannon L Rene, R.D.,L.D.
• Dhanya Renjith, CRNA
• Renpro Texas LLC
• Republic Dental - Pleasanton PLLC
• Republic RX, LLC
• Republic RX, LLC
• Kristina Resendez, NP

• Primary Care Clinic/Center in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.