NPIMap

Individual provider Active NPI

Marvise Ijeoma Oduagu

  • Acute Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1679136220
Registry record updated Apr 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
30020 Issued in TX
Practice address
305 W Commerce St Apt 336
Dallas, TX 75208-1985
Phone
(214) 597-4465
NPI assigned
Apr 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 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 Practitioner 363LA2100X 30020 TX Primary

Addresses

Primary practice location

305 W Commerce St Apt 336
Dallas, TX 75208-1985

Mailing address

305 W Commerce St Apt 336
Dallas, TX 75208-1985
Phone (214) 597-4465

Other identifiers 1

IdentifierTypeStateIssuer
30020OtherTXTEXAS BOARD OF NURSING

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
I20190809001109 TX Practitioner - Nurse Practitioner 4789911025 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
Dallas County Hospital DistrictGroup PAC ID 8325934813, 597 clinicians

Practice addresses (Care Compare)

5200 Harry Hines Blvd
Dallas, TX 75235-7709
Phone (214) 590-8006

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.1 of 100Reported as group
Quality
88.97
Promoting interoperability
79
Improvement activities
40
Cost
83.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30020TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dallas County Hospital District Acute Care Current Accepting new patients
Dallas County Hospital District CurrentSince Jul 23, 2024 Accepting new patients
Backed by Grace PLLC Current Accepting new patients
Dallas County Hospital District CurrentSince Jul 23, 2024 Accepting new patients

Locations

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Backed by Grace PLLCLewisville, TX, CCN 748185 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Corporate Director (50%)
W-2 Managing Employee (50%)		 Feb 5, 2024
Feb 5, 2024
Feb 5, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Backed by Grace PLLC
    • Home Health Agency
    • Lewisville, TX
    • NPI 1174387971

    5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

    CMS ownership

Organizations & group practices 5

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 45

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555632000000",
    "number": "1679136220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W COMMERCE ST APT 336",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752081985",
            "telephone_number": "214-597-4465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W COMMERCE ST APT 336",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752081985",
            "telephone_number": "214-597-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUAGU",
        "first_name": "MARVISE",
        "middle_name": "IJEOMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "30020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD OF NURSING",
            "identifier": "30020",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.