Individual provider Active NPI

Diego Esteban Marra, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1023174414
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
M5353 Issued in TX
Practice address
2801 S Hulen St Ste 400
Fort Worth, TX 76109-1528
Phone
(817) 921-2838
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X M5353 TX
Procedural Dermatology Physician 207NS0135X M5353 TX
MOHS-Micrographic Surgery Physician 207ND0101X M5353 TX Primary

Addresses

Primary practice location

2801 S Hulen St Ste 400
Fort Worth, TX 76109-1528

Mailing address

5310 Harvest Hill Rd Ste 290
Dallas, TX 75230-5826
Phone (214) 420-0650

Other names 1

  • Diego Esteban Garcia-Marra Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070510000582 TX Practitioner - Dermatology 5193821940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Harvard Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

1367 Dominion PLZ
Tyler, TX 75703-1013
Phone (903) 534-6200

Merit-based Incentive Payment System (MIPS)

Final score
99.15 of 100Reported as individual
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision25
Removal of skin lesions77
Removal of skin cancer586
Skin biopsy132

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M5353TXMDProcedural Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Street 5.01(a) Inc. Dermatology CurrentSince Feb 1, 2015 Accepting new patients
Dermatology Associates Dermatology Past Accepting new patients

Locations

6208 Colleyville Blvd
Ste 100
Colleyville, TX 76034
Phone (817) 329-4480

5310 Harvest Hill Rd
Ste 290
Dallas, TX 75230
Phone (214) 420-0672

6117 Berkshire Ln
Dallas, TX 75225
Phone (214) 373-3376

2801 S Hulen St
Fort Worth, TX 76109

2801 S Hulen St
Ste 400
Ft Worth, TX 76109
Phone (817) 921-2838

2321 Ira E Woods Ave
Ste 180
Grapevine, TX 76051
Phone (817) 329-2263

1367 Dominion Plz
Tyler, TX 75703
Phone (903) 534-6200

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507852800000",
    "number": "1023174414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 HARVEST HILL RD STE 290",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752305826",
            "telephone_number": "214-420-0650",
            "fax_number": "214-736-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S HULEN ST STE 400",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091528",
            "telephone_number": "817-921-2838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRA",
        "first_name": "DIEGO",
        "middle_name": "ESTEBAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2017-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "M5353",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TX",
            "license": "M5353",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "M5353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIEGO",
            "last_name": "GARCIA-MARRA",
            "middle_name": "ESTEBAN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.