Maryse Emmerencia Bakouetila, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T3586 Issued in TX

Practice address

2021 N Macarthur Blvd Ste 350
Irving, TX 75061-2217

Phone

(972) 817-1600

NPI assigned

May 28, 2018

Last updated

Nov 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: maryse.bakouetila@42242842558468.direct.elationemr.com

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.

• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936
  Medicare reassignment NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD
• Healthtexas Provider Network

  dba Symmetry Anesthesia

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD

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

{
    "created_epoch": "1527465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1871084632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10902 SHETTLESTON DR",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774072809",
            "telephone_number": "936-649-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 N MACARTHUR BLVD STE 350",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750612217",
            "telephone_number": "972-817-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKOUETILA",
        "first_name": "MARYSE",
        "middle_name": "EMMERENCIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-28",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T3586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Denise Baker
• Angela Baker, PT
• Furhan Abu Baker, BCABA
• Jacob D Baker, CRNA
• Raja Baki
• Balance Xperts PLLC
• Mary Suzanne Balconi-Broome, OTR
• Kailey Brenn Baldree, RBT
• Natalie Louise Baldwin, LCSW
• Casey L Bales, CCRP

• Family Medicine Physician in Irving, TX
• Providers in Irving, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.