Theodora Desronvil, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5010560 Issued in NC

Practice address

300 N Grace St
Rocky Mount, NC 27804-5345

Phone

(252) 210-9856

Fax

(252) 822-5065

NPI assigned

Apr 24, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DRX High Point PLLC 48 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• DRX High Point, PLLC

  • Multi-Specialty Clinic/Center
  • High Point, NC
  • NPI 1669701306

  NC

  Medicare reassignment Care Compare group NPD
• Opportunities Industrialization Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1922020908

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1902394067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2723",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278022723",
            "telephone_number": "252-212-3486",
            "fax_number": "252-212-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N GRACE ST",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278045345",
            "telephone_number": "252-210-9856",
            "fax_number": "252-822-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESRONVIL",
        "first_name": "THEODORA",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-24",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "303827",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5010560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elmer Lowell Denton
• John S Derbyshire, MD
• Nilay Desai, MD
• Priyank Desai, M.D.
• Purvi D Desai, PT
• Determined Home Care Agency LLC
• Devoted Home Care Agency Inc
• Devoted Home Health Agency,Inc
• Devoted Med Services LLC
• Amanpreet Singh Dhaliwal, PA-C

• All providers in Rocky Mount, NC
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.