Individual provider Active NPI

Rebecca A Powell, FNP-C

  • Nurse Practitioner
  • Athens, TX
National Provider Identifier
1265788285
Registry record updated May 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
509858 Issued in TX
Practice address
1505 State Highway 19 S
Athens, TX 75751-8950
Phone
(903) 675-1725
NPI assigned
Jul 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 509858 TX Primary

Addresses

Primary practice location

1505 State Highway 19 S
Athens, TX 75751-8950

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450

Other identifiers 6

IdentifierTypeStateIssuer
306295201MedicaidTX
P02207511OtherTXMEDICARE RAIL ROAD
752616977029OtherTXTRICARE
880N25OtherTXBCBS
306295202MedicaidTX
752616977043OtherTXTRICARE

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
I20120910000887 TX Practitioner - Nurse Practitioner 1658339825 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
509858TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Jul 25, 2012 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Jan 13, 2019 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 25, 2012 Accepting new patients

Locations

1505 State Highway 19 S
Athens, TX 75751
Phone (903) 675-1725

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Interoperability endpoints

  • Direct secure messaging: rpowell14873@christushealth.direct-ci.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558310400000",
    "number": "1265788285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 STATE HIGHWAY 19 S",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757518950",
            "telephone_number": "903-675-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "REBECCA",
        "middle_name": "A",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2019-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "509858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306295201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02207511",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "752616977029",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "880N25",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306295202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "752616977043",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, TX

Sources for this page

Verify at the official NPI Registry.