Mayra Cruz Koedam, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP130975 Issued in TX

Practice address

8160 Walnut Hill LN Ste 306
Dallas, TX 75231-4391

Phone

(214) 345-8060

Fax

(214) 345-8229

NPI assigned

Apr 29, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brightside Medical PCGroup PAC ID 6608262464, 274 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Brightside Medical, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1801355482

  TX

  Medicare reassignment Care Compare group NPD
• Legacy Behavioral Health & Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Plano, TX
  • NPI 1144893173

  Family

  NPD Authorized official
• Legacy Behavioral Health & Wellness

  • Primary Care Nurse Practitioner
  • Plano, TX
  • NPI 1528733359
  NPD Authorized official

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346695178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8160 WALNUT HILL LANE, SUITE 306",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75231",
            "telephone_number": "214-345-8060",
            "fax_number": "214-345-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8160 WALNUT HILL LN STE 306",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314391",
            "telephone_number": "214-345-8060",
            "fax_number": "214-345-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEDAM",
        "first_name": "MAYRA",
        "middle_name": "CRUZ",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP130975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate Kochu, CRNA
• Venkata Gopala Rao Kodali
• Anusha Kodidhi, MD
• Padmavathi Koduri, M.D.
• Prasad R Koduru, PHD
• Alexandra Rose Koehler, MD
• Briana Koehler
• Bruce Eric Koehler II, MD
• Christine Koehler, LPC-S
• Daniel Mark Koehler, M.D.

• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.