Individual provider Active NPI

Mary Jane Hortelano Cubillas, CNP

  • Primary Care Nurse Practitioner
  • Edinburg, TX
National Provider Identifier
1356065320
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
1076370 Issued in TX
Practice address
122 W Champion St
Edinburg, TX 78539-4429
Phone
(195) 628-7120
Fax
(956) 287-1292
NPI assigned
Oct 3, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 1076370 TX Primary

Addresses

Primary practice location

122 W Champion St
Edinburg, TX 78539-4429

Mailing address

1113 W Chapin St
Edinburg, TX 78541-2316
Phone (956) 429-1134

Other identifiers 1

IdentifierTypeStateIssuer
NAOtherNA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://txgwmcapp.eclinicalweb.com/mobiledoc/jsp/webemr/login/newLogin.jsp Health Information Exchange (HIE)

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
I20221017002594 TX Practitioner - Nurse Practitioner 6305212341

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

122 W Champion St
Edinburg, TX 78539-4429

Hospital & facility affiliations

  • Doctors Hosptal at Renaissance Hospital, Edinburg, TX, CCN 450869

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1076370TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Antonio Wong,MD & Associates,PA CurrentSince Oct 1, 2022 Accepting new patients

Locations

122 W Champion St
Edinburg, TX 78539
Phone (956) 287-1207

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 2

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": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1356065320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 W CHAPIN ST",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785412316",
            "telephone_number": "956-429-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 W CHAMPION ST",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785394429",
            "telephone_number": "195-628-7120",
            "fax_number": "956-287-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORTELANO CUBILLAS",
        "first_name": "MARY JANE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "1076370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "NA",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://txgwmcapp.eclinicalweb.com/mobiledoc/jsp/webemr/login/newLogin.jsp",
            "affiliation": "N",
            "endpointDescription": "eClinicalWorks",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "122 W Champion St",
            "city": "Edinburg",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785394429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edinburg, TX

Sources for this page

Verify at the official NPI Registry.