NPIMap

Organization Active NPI

Collin Medical & Wellness Group PLLC

  • Family Nurse Practitioner
  • Rowlett, TX
National Provider Identifier
1134730534
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
COLLIN MEDICAL & WELLNESS GROUP PLLC
Practice address
9400 Lakeview Pkwy Ste 111
Rowlett, TX 75088-4434
Phone
(469) 270-7854
Fax
(469) 329-1044
NPI assigned
Aug 11, 2020
Last updated
Aug 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Authorized official

Name
Adebukola Obasanya, FNPNPI 1356901581
Title
Owner
Phone
(469) 270-7854

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

9400 Lakeview Pkwy Ste 111
Rowlett, TX 75088-4434

Mailing address

6841 Virginia Pkwy Ste 103-307
McKinney, TX 75071-5710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200820000934 TX Part B Supplier - Clinic/Group Practice 4587080593 Receives reassigned benefits from 8 practitioners
Practice locations: McKinney, TX

National Provider Directory

National Provider Directory

Locations

6841 Virginia Pkwy
Ste 103307
McKinney, TX 75071

9400 Lakeview Pkwy
Ste 111
Rowlett, TX 75088
Phone (469) 270-7854

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25728/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1134730534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6841 VIRGINIA PKWY STE 103-307",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750715710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 LAKEVIEW PKWY STE 111",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750884434",
            "telephone_number": "469-270-7854",
            "fax_number": "469-329-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIN MEDICAL & WELLNESS GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "OBASANYA",
        "authorized_official_first_name": "ADEBUKOLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-270-7854",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rowlett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.