NPIMap

Individual provider Active NPI

Rossalya Aracely Granda Gutierrez

  • Medical Physician Assistant
  • Flower Mound, TX
National Provider Identifier
1053957910
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA13107 Issued in TX
Practice address
3101 Churchill Dr Ste 100
Flower Mound, TX 75022-2717
Phone
(210) 582-5304
Fax
(210) 582-5307
NPI assigned
Nov 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA13107 TX Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

3101 Churchill Dr Ste 100
Flower Mound, TX 75022-2717

Mailing address

935 Spring Valley PLZ
Richardson, TX 75080-6727

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200108001100 TX Practitioner - Physician Assistant 9335574938 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RRR Hyperbarics 4Group PAC ID 9537421482, 7 clinicians

Practice addresses (Care Compare)

1720 FM
544 Suite 100
Lewisville, TX 75056-4592
Phone (817) 337-6604

9151 Boulevard
26 Suite 150B
North Richland Hills, TX 76180-5600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA13107TXMDMedical Physician Assistant

Organizations & group practices 8

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": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1053957910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 SPRING VALLEY PLZ",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750806727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 CHURCHILL DR STE 100",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750222717",
            "telephone_number": "210-582-5304",
            "fax_number": "210-582-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDA GUTIERREZ",
        "first_name": "ROSSALYA",
        "middle_name": "ARACELY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA13107",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flower Mound, TX

Sources for this page

Verify at the official NPI Registry.