Individual provider Active NPI

Ernesto Marrero, MSN, FNP

  • Nurse Practitioner
  • Round Rock, TX
National Provider Identifier
1104428416
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F11200009 Issued in TX
Practice address
2631 Gattis School Rd Ste 150
Round Rock, TX 78664-2825
Phone
(512) 243-5872
Fax
(512) 243-7130
NPI assigned
Nov 11, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F11200009 TX Primary

Addresses

Primary practice location

2631 Gattis School Rd Ste 150
Round Rock, TX 78664-2825

Mailing address

2631 Gattis School Rd Ste 150
Round Rock, TX 78664-2825
Phone (512) 243-5872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210729001695 TX Practitioner - Nurse Practitioner 6507269453 Reassigns benefits to 1 organization
I20250128001210 NY Practitioner - Nurse Practitioner 6507269453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Doral Medical and Multi Specialty Facility LLCGroup PAC ID 9830528645, 53 clinicians

Practice addresses (Care Compare)

1797 Pitkin Ave
Suite 2
Brooklyn, NY 11212-7844
Phone (718) 971-1944

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F11200009TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Viva Health Clinic, LLC Nurse Practitioner CurrentSince Feb 11, 2023 Accepting new patients
Doral Medical and Multi Specialty Facility LLC CurrentSince Nov 1, 2024 Accepting new patients
Graciela M Leija MD PA Past Accepting new patients
Doral Pharmacy LLC PastSince Nov 1, 2024 Accepting new patients

Locations

1797 Pitkin Ave
Ste 2
Brooklyn, NY 11212
Phone (718) 367-2555

1797 Pitkin Ave
Brooklyn, NY 11212
Phone (718) 367-2555

2631 Gattis School Rd
Ste 150
Round Rock, TX 78664
Phone (512) 243-5872

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: ernesto.marrero@398008301912068.direct.elationemr.com
  • Direct secure messaging: ernesto.marrero@cinq-nyipa.medentdirect.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/BCHBDD/Endpoint/BCHBDD

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.

NPI Registry JSON

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

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1104428416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 GATTIS SCHOOL RD STE 150",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642825",
            "telephone_number": "512-243-5872",
            "fax_number": "512-243-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 GATTIS SCHOOL RD STE 150",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786642825",
            "telephone_number": "512-243-5872",
            "fax_number": "512-243-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRERO",
        "first_name": "ERNESTO",
        "name_prefix": "Mr.",
        "credential": "MSN, FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-11",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "F11200009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.