NPIMap

Individual provider Active NPI

Marvic Maria Taborda Alvarez

  • Pediatrics Physician
  • Eagle Pass, TX
National Provider Identifier
1083100614
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
S9805 Issued in TX
Practice address
4018 El Indio Hwy
Eagle Pass, TX 78852-6690
Phone
(830) 872-3460
Fax
(830) 872-3470
NPI assigned
Jul 6, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X S9805 TX Primary

Addresses

Primary practice location

4018 El Indio Hwy
Eagle Pass, TX 78852-6690

Mailing address

PO Box 1470
Eagle Pass, TX 78853-1470
Phone (830) 773-8917

Other practice location 1

1 Brookdale Plz
Brooklyn, NY 11212-3139
Phone (718) 240-5277

Other identifiers 2

IdentifierTypeStateIssuer
1346380870MedicaidNY
4302259-01MedicaidTX

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
I20210902000730 TX Practitioner - Pediatric Medicine 4587060389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Medical CentersGroup PAC ID 7618957135, 23 clinicians

Practice addresses (Care Compare)

2525 N Veterans Blvd
Eagle Pass, TX 78852-3302
Phone (830) 773-5358

4018 El Indio Hwy
Eagle Pass, TX 78852-6690
Phone (830) 872-3460

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S9805TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Centers Pediatrics CurrentSince Jul 6, 2021 Accepting new patients
United Medical Centers Pediatrics CurrentSince Jul 6, 2021 Accepting new patients
United Medical Centers Pediatrics Past Accepting new patients
Fort Duncan Medical Center LP Past Accepting new patients

Locations

4018 El Indio Hwy
Eagle Pass, TX 78852
Phone (830) 776-8917

2525 N Veterans Blvd
Eagle Pass, TX 78852
Phone (830) 773-5358

Interoperability endpoints

  • Direct secure messaging: marvic.tabordaalvarez.p1@direct.umchealth.nextgenshare.com

Organizations & group practices 12

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": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1083100614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1470",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788531470",
            "telephone_number": "830-773-8917",
            "fax_number": "830-773-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4018 EL INDIO HWY",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788526690",
            "telephone_number": "830-872-3460",
            "fax_number": "830-872-3470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Brookdale Plz",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112123139",
            "country_code": "US",
            "telephone_number": "718-240-5277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABORDA ALVAREZ",
        "first_name": "MARVIC",
        "middle_name": "MARIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-06",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "S9805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346380870",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4302259-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle Pass, TX

Sources for this page

Verify at the official NPI Registry.