Active NPI
Robert Marriott Medical Corp
- Surgery Physician
- Mesquite, TX
National Provider Identifier
1164973012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- ROBERT MARRIOTT MEDICAL CORP
- Practice address
- 711 Matador LN
Mesquite, TX 75149-8830 - Phone
- (877) 878-3289
- Fax
- (877) 817-3227
- NPI assigned
- Oct 16, 2016
- Last updated
- Nov 8, 2018
- Organization subpart
- Yes
- Parent organization
- ADVANTAGE WOUNDCARE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert J Marriott, MD
- Title
- Ceo
- Phone
- (877) 878-3289
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | NU | Primary |
Addresses
Primary practice location
711 Matador LN
Mesquite, TX 75149-8830
Mailing address
222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 878-3289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3216269-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090518000379 | TX | Part B Supplier - Clinic/Group Practice | 2567531494 |
Receives reassigned benefits from 47 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Advantage Wound Care
- Surgery Physician
- El Segundo, CA
- NPI 1083883938
O20090518000379
National Provider Directory
National Provider Directory- Part of
- Parmount Meadows
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Surgery Physician
- El Segundo, CA
- NPI 1700804887
-
- Family Nurse Practitioner
- Webster, TX
- NPI 1891688834
-
- Family Nurse Practitioner
- Odessa, TX
- NPI 1336801760
-
- Family Nurse Practitioner
- San Diego, CA
- NPI 1700266251
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476576000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1541635200000",
"number": "1164973012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 N PACIFIC COAST HWY STE 2175",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902455639",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 MATADOR LN",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751498830",
"telephone_number": "877-878-3289",
"fax_number": "877-817-3227"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROBERT MARRIOTT MEDICAL CORP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ADVANTAGE WOUNDCARE",
"enumeration_date": "2016-10-16",
"last_updated": "2018-11-08",
"status": "A",
"authorized_official_last_name": "MARRIOTT",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "877-878-3289",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3216269-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
- RLS Supermarkets LLC (Minyard Pharmacy)
- Rmbo Enterprises LTD (Town East Diagnostic and Therapy Center)
- Ro Priority Home Health Agency, Inc
- Roann Behavioral Health Clinic PLLC
- Robert a. Young
- Caroline Monica Roberts-Daley
- Gary Frey Roberts, MD
- Jessika Roberts
- Rodney Lee Robertson, OD
- Audrey Maureen Robinson, PH.D., LPC-S, RPT-S
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.