NPIMap

Individual provider Active NPI

Nevena Pavlovic Willcox, MD

  • Family Medicine Physician
  • Grapevine, TX
National Provider Identifier
1609076637
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
Q4708 Issued in TX
Practice address
1650 W College St
Suite 150
Grapevine, TX 76051-3565
Phone
(817) 388-3440
Fax
(817) 388-3441
NPI assigned
Jul 18, 2007
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X Q4708 TX Primary

Addresses

Primary practice location

1650 W College St
Suite 150
Grapevine, TX 76051-3565

Mailing address

1650 W College St
Suite 150
Grapevine, TX 76051-3565
Phone (817) 388-3440

Other identifiers 1

IdentifierTypeStateIssuer
440163501OtherARAR MEDICAID TEMP RX NUMBE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nwillcox226020@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160223002122 TX Practitioner - Family Practice 4880718857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

1650 W College St
Grapevine, TX 76051-3565
Phone (817) 388-3440

4001 Worth St
Dallas, TX 75246-1608

5408 Colleyville Blvd
Colleyville, TX 76034-5833
Phone (817) 498-9920

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthtexas Provider Network CurrentSince Jan 4, 2016 Accepting new patients
Healthtexas Provider Network Family Medicine CurrentSince Jan 4, 2016 Accepting new patients
Healthtexas Provider Network Family Medicine Current Accepting new patients
Healthtexas Provider Network Family Medicine Past Accepting new patients

Locations

5408 Colleyville Blvd
Colleyville, TX 76034
Phone (817) 498-9920

4001 Worth St
#A
Dallas, TX 75246
Phone (214) 820-8665

8080 N Central Expy
Ste 600
Dallas, TX 75206
Phone (469) 800-8648

1650 W College St
Ste 150
Grapevine, TX 76051
Phone (817) 338-3440

Organizations & group practices 4

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 6

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": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1609076637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 W COLLEGE ST",
            "address_2": "SUITE 150",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513565",
            "telephone_number": "817-388-3440",
            "fax_number": "817-388-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W COLLEGE ST",
            "address_2": "SUITE 150",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513565",
            "telephone_number": "817-388-3440",
            "fax_number": "817-388-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLCOX",
        "first_name": "NEVENA",
        "middle_name": "PAVLOVIC",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-18",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q4708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR MEDICAID TEMP RX NUMBE",
            "identifier": "440163501",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nwillcox226020@direct.sw.org",
            "affiliation": "N",
            "address_1": "1650 W College St",
            "address_2": "Suite 150",
            "city": "Grapevine",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760513565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.