Individual provider Active NPI

Angie Molina Barajaz, APRN, AGACNP-BC

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1245949312
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP1091094 Issued in TX
Practice address
1133 Medical Dr
Tyler, TX 75701-2130
Phone
(903) 595-5486
Fax
(903) 595-5128
NPI assigned
Nov 17, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 891373 TX
Acute Care Nurse Practitioner 363LA2100X 1091094 TX
Nurse Practitioner 363L00000X AP1091094 TX Primary

Addresses

Primary practice location

1133 Medical Dr
Tyler, TX 75701-2130

Mailing address

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

Other practice location 1

20550 Bluegrass Cir
Flint, TX 75762-8759
Phone (903) 705-2425

Other names 1

  • Angie Molina 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
I20230112002780 TX Practitioner - Nurse Practitioner 7416328208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tyler Nephrology Associates PAGroup PAC ID 6901862242, 27 clinicians

Practice addresses (Care Compare)

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

Hospital & facility affiliations

  • Ut Health East Texas Jacksonville Hospital Hospital, Jacksonville, TX, CCN 450194
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Christus Mother Frances Hospital- Jacksonville Hospital, Jacksonville, TX, CCN 451319
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
891373TXMDRegistered Nurse
AP1091094TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Nephrology Associates, P.a. CurrentSince Jan 3, 2023 Accepting new patients

Locations

203 Nacogdoches St
Ste 240
Jacksonville, TX 75766
Phone (903) 541-5452

1133 Medical Dr
Tyler, TX 75701
Phone 9035955486173

Interoperability endpoints

  • Direct secure messaging: amolina47691@direct.acumenmd.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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 4

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": "1668643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1245949312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20550 Bluegrass Cir",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "TX",
            "postal_code": "757628759",
            "country_code": "US",
            "telephone_number": "903-705-2425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARAJAZ",
        "first_name": "ANGIE",
        "middle_name": "MOLINA",
        "credential": "APRN, AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-17",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "891373",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1091094",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP1091094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGIE",
            "last_name": "MOLINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.