Individual provider Active NPI

Blexy Jigi Abraham, APRN

  • Primary Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1124574157
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP131743 Issued in TX
Practice address
2121 S Buckner Blvd Ste 100
Dallas, TX 75227-8602
Phone
(214) 381-1187
Fax
(214) 381-7213
NPI assigned
Aug 30, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP131743 TX
Primary Care Nurse Practitioner 363LP2300X AP131743 TX Primary

Addresses

Primary practice location

2121 S Buckner Blvd Ste 100
Dallas, TX 75227-8602

Mailing address

2121 S Buckner Blvd Ste 100
Dallas, TX 75227-8602
Phone (214) 381-1187

Other identifiers 1

IdentifierTypeStateIssuer
384319501MedicaidTX

Other names 1

  • Blexy Susan Jose Former name

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
I20161024000411 TX Practitioner - Nurse Practitioner 9638457864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

6157 NW Loop 410
124 Wellmed at Ingram Park
San Antonio, TX 78238-3302
Phone (210) 523-1411

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP131743TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Group, P.a. CurrentSince Sep 25, 2017 Accepting new patients
Wellmed Medical Group, PA CurrentSince Sep 25, 2017 Accepting new patients

Locations

2121 S Buckner Blvd
Ste 100
Dallas, TX 75227
Phone (214) 381-1187

2942 S Buckner Blvd
Dallas, TX 75227
Phone (214) 381-1186

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

Interoperability endpoints

  • Direct secure messaging: blexy.abraham@wellmed.eclinicaldirectplus.com

Organizations & group practices 3

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": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1124574157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 S BUCKNER BLVD STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752278602",
            "telephone_number": "214-381-1187",
            "fax_number": "214-381-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S BUCKNER BLVD STE 100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752278602",
            "telephone_number": "214-381-1187",
            "fax_number": "214-381-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABRAHAM",
        "first_name": "BLEXY",
        "middle_name": "JIGI",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP131743",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP131743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "384319501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BLEXY",
            "last_name": "JOSE",
            "middle_name": "SUSAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.