Individual provider Active NPI

Roelson Rodriguez, AGACNP

  • Family Nurse Practitioner
  • El Paso, TX
National Provider Identifier
1154919918
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1021163 Issued in TX
Practice address
1512 N Zaragoza Rd Ste B
El Paso, TX 79936-8903
Phone
(915) 213-0900
Fax
(915) 271-4145
NPI assigned
Jan 7, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1021163 TX Primary

Addresses

Primary practice location

1512 N Zaragoza Rd Ste B
El Paso, TX 79936-8903

Mailing address

1512 N Zaragoza Rd Ste B
El Paso, TX 79936-8903
Phone (915) 213-0900

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
I20210315002135 TX Practitioner - Nurse Practitioner 4284040320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Asad Omar MD PAGroup PAC ID 4486938586, 9 clinicians

Practice addresses (Care Compare)

1512 N Zaragoza Rd
Suite B
El Paso, TX 79936-8903
Phone (915) 249-3900

Hospital & facility affiliations

  • The Hospitals of Providence - East Campus Hospital, El Paso, TX, CCN 670047
  • Las Palmas Medical Center a Campus of LPDS Healthc Hospital, El Paso, TX, CCN 450107

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
91.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1021163TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Global PLLC CurrentSince Jul 1, 2025 Accepting new patients
Fahad Omar MD PA CurrentSince Jan 1, 2021 Accepting new patients
Asad Omar MD PA CurrentSince Feb 17, 2021 Accepting new patients

Locations

5539 N Mesa St
El Paso, TX 79912

1512 N Zaragoza Rd
Ste B
El Paso, TX 79936
Phone (915) 249-3900

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1154919918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 N ZARAGOZA RD STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799368903",
            "telephone_number": "915-213-0900",
            "fax_number": "915-271-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N ZARAGOZA RD STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799368903",
            "telephone_number": "915-213-0900",
            "fax_number": "915-271-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ROELSON",
        "name_prefix": "Mr.",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1021163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.