NPIMap

Individual provider Active NPI

Collins O Idiegbe, ACNP

  • Acute Care Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1073940557
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
751397 Issued in TX
Practice address
4411 Medical Dr
300
San Antonio, TX 78229-3822
Phone
(210) 614-5400
Fax
(210) 614-5732
NPI assigned
Sep 30, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 751397 TX Primary

Addresses

Primary practice location

4411 Medical Dr
300
San Antonio, TX 78229-3822

Mailing address

4411 Medical Dr
300
San Antonio, TX 78229-3822
Phone (210) 614-5400

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
I20150416000545 TX Practitioner - Nurse Practitioner 6507093887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dallas County Hospital DistrictGroup PAC ID 8325934813, 597 clinicians

Practice addresses (Care Compare)

1800 N Britain Rd
Parkland Health
Irving, TX 75061-2630
Phone (214) 266-3000

5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone (214) 590-8006

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.1 of 100Reported as group
Quality
88.97
Promoting interoperability
79
Improvement activities
40
Cost
83.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
751397TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Hospital District CurrentSince Mar 25, 2015 Accepting new patients
Dallas County Hospital District Acute Care Current Accepting new patients
Dallas County Hospital District CurrentSince Mar 25, 2015 Accepting new patients

Locations

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

Interoperability endpoints

  • Direct secure messaging: cidiegbe45224@direct.phhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 45

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1073940557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 MEDICAL DR",
            "address_2": "300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293822",
            "telephone_number": "210-614-5400",
            "fax_number": "210-614-5732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 MEDICAL DR",
            "address_2": "300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293822",
            "telephone_number": "210-614-5400",
            "fax_number": "210-614-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDIEGBE",
        "first_name": "COLLINS",
        "middle_name": "O",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-30",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "751397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.