Individual provider Active NPI

Jessie Sales Bernabe, ACNP-BC

  • Acute Care Nurse Practitioner
  • Grand Prairie, TX
National Provider Identifier
1386100717
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP140250 Issued in TX
Practice address
5203 Lake Ridge Pkwy
Grand Prairie, TX 75052-3006
Phone
(682) 218-5400
NPI assigned
Feb 11, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2100X AP140250 TX Primary

Addresses

Primary practice location

5203 Lake Ridge Pkwy
Grand Prairie, TX 75052-3006

Mailing address

5203 Lake Ridge Pkwy
Grand Prairie, TX 75052-3006
Phone (682) 218-5400

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
I20190620000438 TX Practitioner - Nurse Practitioner 7214261528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cogent Healthcare of Texas PAGroup PAC ID 8628076924, 113 clinicians

Practice addresses (Care Compare)

6200 W Parker Rd
Texas Health Presbyterian Hospital
Plano, TX 75093-8185
Phone (972) 981-8010

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Texas, PA Single Specialty CurrentSince Jan 1, 2023 Accepting new patients
Revive Med Partners, LLC Single Specialty Past Accepting new patients

Locations

1950 Record Crossing Rd
Dallas, TX 75235
Phone (214) 638-1500

8200 Walnut Hill Ln
Dallas, TX 75231
Phone (214) 345-6148

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Organizations & group practices 2

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": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1386100717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5203 LAKE RIDGE PKWY",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523006",
            "telephone_number": "682-218-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 LAKE RIDGE PKWY",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750523006",
            "telephone_number": "682-218-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNABE",
        "first_name": "JESSIE",
        "middle_name": "SALES",
        "credential": "ACNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-11",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP140250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Prairie, TX

Sources for this page

Verify at the official NPI Registry.