Individual provider Active NPI

Gloria Perales Solis, NP-C

  • Family Nurse Practitioner
  • Portland, TX
National Provider Identifier
1265873095
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
718110 Issued in TX
Practice address
1500 Wildcat Dr Ste C
Portland, TX 78374-2826
Phone
(361) 643-9800
Fax
(361) 643-5112
NPI assigned
Jul 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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 718110 TX Primary

Addresses

Primary practice location

1500 Wildcat Dr Ste C
Portland, TX 78374-2826

Mailing address

1500 Wildcat Dr Ste C
Portland, TX 78374-2826
Phone (361) 643-9800

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
I20140312000266 TX Practitioner - Nurse Practitioner 4284864364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charles Gregory DO PAGroup PAC ID 6002838919, 3 clinicians

Practice addresses (Care Compare)

1500 Wildcat Dr
Suite C
Portland, TX 78374-2826
Phone (361) 643-9800

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
718110TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Charles Gregory, DO PA CurrentSince Mar 1, 2014 Accepting new patients

Locations

1500 Wildcat Dr
Ste C
Portland, TX 78374
Phone (361) 643-9800

311 Buddy Ganem Dr
#B
Portland, TX 78374
Phone (361) 634-9800

311B Buddy Ganem Dr
Portland, TX 78374
Phone (361) 643-9800

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.

NPI Registry JSON

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1265873095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 WILDCAT DR STE C",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783742826",
            "telephone_number": "361-643-9800",
            "fax_number": "361-643-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 WILDCAT DR STE C",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "783742826",
            "telephone_number": "361-643-9800",
            "fax_number": "361-643-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLIS",
        "first_name": "GLORIA",
        "middle_name": "PERALES",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "718110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, TX

Sources for this page

Verify at the official NPI Registry.