Individual provider Active NPI

Christina Desousa Rose, M.D., M.P.H.

  • Neurology Physician
  • Fort Worth, TX
National Provider Identifier
1275740847
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301088749 Issued in MI
Practice address
1400 S Main St Ste 502
Fort Worth, TX 76104-4909
Phone
(817) 702-8400
NPI assigned
May 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301088749 MI Primary

Addresses

Primary practice location

1400 S Main St Ste 502
Fort Worth, TX 76104-4909

Mailing address

5141 Oakman Blvd
Dearborn, MI 48126-3763
Phone (313) 846-8840

Other practice location 1

5141 Oakman Blvd
Dearborn, MI 48126-3763
Phone (313) 846-8840

Other identifiers 2

IdentifierTypeStateIssuer
V4061OtherTXLICENSE
4301088749OtherMILICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110606000728 MI Practitioner - Neurology 0244417939 Reassigns benefits to 3 organizations
I20241017000479 TX Practitioner - Neurology 0244417939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Wayne State University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

1400 S Main St
Suite 502
Fort Worth, TX 76104-4909
Phone (817) 702-8400

5141 Oakman Blvd
Dearborn, MI 48126-3763
Phone (313) 846-3057

850 W Baraga Ave
Marquette, MI 49855-4550
Phone (906) 449-3610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Oakleaf Neurology & Sleep P C CurrentSince Jun 1, 2011 Accepting new patients
Rose Neurology, PC CurrentSince Mar 1, 2020 Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Nov 1, 2022 Accepting new patients
DLP Marquette Physician Practices Inc Neurology CurrentSince Nov 1, 2022 Accepting new patients
Acclaim Physician Group, Inc CurrentSince Oct 4, 2024 Accepting new patients
University of Texas Health Science Center at Tyler-Facility-Physician PastSince Oct 4, 2024 Accepting new patients
DLP Marquette Physician Practices Inc Past Accepting new patients

Locations

5141 Oakman Blvd
Ste A
Dearborn, MI 48126
Phone (313) 846-8840

5141 Oakman Blvd
Dearborn, MI 48126
Phone (313) 359-8200

850 W Baraga Ave
Ste 31
Marquette, MI 49855
Phone (906) 449-3600

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

1400 S Main St
Ste 502
Fort Worth, TX 76104
Phone (817) 702-8400

1350 S Main St
Fl 1
Fort Worth, TX 76104
Phone (817) 702-3701

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

200 W Magnolia Ave
Ste 201
Ft Worth, TX 76104
Phone (817) 702-2450

Interoperability endpoints

  • Direct secure messaging: cdesousa@direct.dmc.org
  • Direct secure messaging: christina.rose.1@8233.direct.athenahealth.com

Organizations & group practices 7

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 5

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": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1275740847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5141 OAKMAN BLVD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263763",
            "telephone_number": "313-846-8840",
            "fax_number": "313-846-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S MAIN ST STE 502",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044909",
            "telephone_number": "817-702-8400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5141 OAKMAN BLVD",
            "address_purpose": "LOCATION",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263763",
            "country_code": "US",
            "telephone_number": "313-846-8840",
            "fax_number": "313-846-1540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSE",
        "first_name": "CHRISTINA",
        "middle_name": "DESOUSA",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301088749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "V4061",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4301088749",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.