Individual provider Active NPI

Roselio Perez Garcia, FNP

  • Family Nurse Practitioner
  • Mesquite, TX
National Provider Identifier
1043780513
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F11180340 Issued in FL
Practice address
2110 N Galloway Ave Ste 108
Mesquite, TX 75150-5779
Phone
(972) 634-4871
Fax
(972) 584-9607
NPI assigned
Nov 27, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP142189 TX
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X F11180340 FL Primary

Addresses

Primary practice location

2110 N Galloway Ave Ste 108
Mesquite, TX 75150-5779

Mailing address

2110 N Galloway Ave Ste 108
Mesquite, TX 75150-5779
Phone (305) 539-8084

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230816001878 TX Practitioner - Nurse Practitioner 0941699755 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F11180340FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Desoto Healthcare Clinic LLC Multi-Specialty CurrentSince Dec 1, 2023 Accepting new patients
Clinica de la Familia Hispana Ebenezer LLC Multi-Specialty CurrentSince Sep 16, 2024 Accepting new patients
Clinica Hispana Lancaster LLC Multi-Specialty CurrentSince Aug 1, 2024 Accepting new patients
Odette Louise Campbell MD PA Multi-Specialty CurrentSince Feb 12, 2024 Accepting new patients
Happy Bridge Primary Care & Home Health PLLC Multi-Specialty PastSince Nov 6, 2025 Accepting new patients

Locations

522 Bedford Rd
Bedford, TX 76022
Phone (682) 738-3358

3250 W Pleasant Run Rd
Ste 160
Lancaster, TX 75146
Phone (469) 747-3005

860 Hebron Pkwy
Ste 704
Lewisville, TX 75057
Phone (214) 777-2703

5072 W Plano Pkwy
Ste 220
Plano, TX 75093
Phone (469) 671-0900

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BJEDCD/Endpoint/BJEDCD

Organizations & group practices 6

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": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1043780513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 N GALLOWAY AVE STE 108",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751505779",
            "telephone_number": "305-539-8084",
            "fax_number": "469-206-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 N GALLOWAY AVE STE 108",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751505779",
            "telephone_number": "972-634-4871",
            "fax_number": "972-584-9607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ GARCIA",
        "first_name": "ROSELIO",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-27",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP142189",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "F11180340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesquite, TX

Sources for this page

Verify at the official NPI Registry.