Individual provider Active NPI

Maricelle G Sorolla Olympia, MD

  • Internal Medicine Physician
  • Grapevine, TX
National Provider Identifier
1194716720
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N8064 Issued in TX
Practice address
1650 W College St Ste 150
Grapevine, TX 76051-3565
Phone
(817) 388-3440
Fax
(817) 388-3441
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X N8064 TX Primary

Addresses

Primary practice location

1650 W College St Ste 150
Grapevine, TX 76051-3565

Mailing address

1650 W College St Ste 150
Grapevine, TX 76051-3565
Phone (817) 388-3440

Other identifiers 1

IdentifierTypeStateIssuer
219963001MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msorollaolympia292799@direct.sw.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110325000233 TX Practitioner - Internal Medicine 5799741955 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1650 W College St
Grapevine, TX 76051-3565
Phone (817) 388-3440

4001 Worth St
Dallas, TX 75246-1608

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

Hospital & facility affiliations

  • Baylor Scott & White Medical Center Grapevine Hospital, Grapevine, TX, CCN 450563
  • Baylor Scott & White Emergency Hospital Hospital, Aubrey, TX, CCN 670062

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N8064TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network Internal Medicine CurrentSince Sep 11, 2017 Accepting new patients
Healthtexas Provider Network Internal Medicine Current Accepting new patients
Healthtexas Provider Network CurrentSince Sep 11, 2017 Accepting new patients
Healthtexas Provider Network Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (972) 860-8648

1650 W College St
Ste 150
Grapevine, TX 76051
Phone (817) 338-3440

Interoperability endpoints

  • Direct secure messaging: maricelle.sorolla-olympia.1@18148.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1194716720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 W COLLEGE ST STE 150",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513565",
            "telephone_number": "817-388-3440",
            "fax_number": "817-388-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W COLLEGE ST STE 150",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513565",
            "telephone_number": "817-388-3440",
            "fax_number": "817-388-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOROLLA OLYMPIA",
        "first_name": "MARICELLE",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N8064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "219963001",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msorollaolympia292799@direct.sw.org",
            "affiliation": "N",
            "address_1": "1650 W College St Ste 150",
            "city": "Grapevine",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760513565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.