Individual provider Active NPI

Elyssee Frejoles, NP-C

  • Gerontology Nurse Practitioner
  • Temple, TX
National Provider Identifier
1871942508
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AP140133 Issued in TX
Practice address
2401 S 31St St
Temple, TX 76508-0001
Phone
(254) 724-2111
Fax
(254) 724-7603
NPI assigned
Jun 3, 2016
Last updated
May 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP140133 TX Primary

Addresses

Primary practice location

2401 S 31St St
Temple, TX 76508-0001

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other identifiers 3

IdentifierTypeStateIssuer
8LT457OtherTXBCBS
403558602OtherTXCSHCN MEDICAID
403558601MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address efrejoles809394@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171205002231 NY Practitioner - Nurse Practitioner 5294021911 Reassigns benefits to 1 organization
I20191016003067 TX Practitioner - Nurse Practitioner 5294021911 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP140133TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
TMH Physician Associates PLLC CurrentSince Feb 5, 2024 Accepting new patients
TMH Physician Associates PLLC CurrentSince Feb 5, 2024 Accepting new patients
Specialty Associates of West Houston PLLC CurrentSince Dec 1, 2024 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 10, 2017 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 10, 2017 Accepting new patients

Locations

1190 5th Ave
#2W
New York, NY 10029
Phone (212) 241-5646

150 E 42nd St
New York, NY 10017
Phone (212) 661-8139

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

146 E Hospital Dr
Ste 201
Angleton, TX 77515
Phone (409) 849-1414

1140 Business Center Dr
Ste 490
Houston, TX 77043
Phone (713) 932-1247

7575 San Felipe St
Ste 155
Houston, TX 77063
Phone (713) 266-9955

11100 Shadow Creek Pkwy
Pearland, TX 77584
Phone (713) 770-7000

15200 Southwest Fwy
Ste 290
Sugar Land, TX 77478
Phone (281) 980-2010

16605 Southwest Fwy
Ste 400
Sugar Land, TX 77479
Phone (281) 275-0800

Interoperability endpoints

  • Direct secure messaging: efrejoles809394@direct.sw.org
  • Direct secure messaging: elyssee.frejoles@hca9.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1871942508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-2111",
            "fax_number": "254-724-7603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREJOLES",
        "first_name": "ELYSSEE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP140133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LT457",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN MEDICAID",
            "identifier": "403558602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403558601",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efrejoles809394@direct.sw.org",
            "affiliation": "N",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765080001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.