Individual provider Active NPI

Ma Ellen Novicio, APRN

  • Nurse Practitioner
  • Odessa, TX
National Provider Identifier
1578503231
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP110326 Issued in TX
Practice address
720 Golder Ave
Odessa, TX 79761-4442
Phone
(432) 337-3117
Fax
(432) 640-2868
NPI assigned
Jun 8, 2006
Last updated
Apr 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP110326 TX Primary

Addresses

Primary practice location

720 Golder Ave
Odessa, TX 79761-4442

Mailing address

PO Box 2129
Odessa, TX 79760-2129
Phone (432) 337-3117

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
I20190404002428 TX Practitioner - Nurse Practitioner 2769384379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCH Professional CareGroup PAC ID 1658358635, 51 clinicians

Practice addresses (Care Compare)

720 Golder Ave
Odessa, TX 79761-4442
Phone (432) 337-3117

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.78 of 100Reported as group
Quality
60.9
Promoting interoperability
100
Improvement activities
40
Cost
66.21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP110326TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCH Professional Care CurrentSince Apr 1, 2020 Accepting new patients
Ector County Hospital District Past Accepting new patients
Heart Specialists PC of Southern Connecticut Past Accepting new patients

Locations

315 Golder Ave
Ste B
Odessa, TX 79761
Phone (432) 332-2695

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

720 Golder Ave
Odessa, TX 79761
Phone (915) 337-3117

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1578503231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2129",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797602129",
            "telephone_number": "432-337-3117",
            "fax_number": "432-640-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 GOLDER AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614442",
            "telephone_number": "432-337-3117",
            "fax_number": "432-640-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVICIO",
        "first_name": "MA ELLEN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP110326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.