Individual provider Active NPI

Vanessa Rotibi

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1679315543
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1077217 Issued in TX
Practice address
5832 Water Ridge CT
Fort Worth, TX 76179-7568
Phone
(405) 413-1546
NPI assigned
Jun 11, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1077217 TX Primary

Addresses

Primary practice location

5832 Water Ridge CT
Fort Worth, TX 76179-7568

Mailing address

5832 Water Ridge CT
Fort Worth, TX 76179-7568
Phone (405) 413-1546

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
I20240921000105 TX Practitioner - Nurse Practitioner 4082155775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MD Trucare PAGroup PAC ID 1557643467, 17 clinicians

Practice addresses (Care Compare)

823 Ira E Woods Ave
Suite 200
Grapevine, TX 76051-4096
Phone (817) 722-6078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1077217TXMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MD Trucare PA CurrentSince Sep 1, 2024 Accepting new patients

Locations

10640 N Riverside Dr
Ste 300
Fort Worth, TX 76244
Phone (817) 722-6078

823 Ira E Woods Ave
Ste 200
Grapevine, TX 76051
Phone (817) 421-9999

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AJHDBD

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.

NPI Registry JSON

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1679315543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5832 WATER RIDGE CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761797568",
            "telephone_number": "405-413-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5832 WATER RIDGE CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761797568",
            "telephone_number": "405-413-1546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTIBI",
        "first_name": "VANESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1077217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.