Individual provider Active NPI

Adrian Jane Raabe, AGPCNP-BC, APRN

  • Adult Health Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1982901781
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
AP119771 Issued in TX
Practice address
4500 S Lancaster Rd
Dallas, TX 75216-7167
Phone
(469) 797-2101
Fax
(817) 730-0510
NPI assigned
Feb 15, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP119771 TX
Adult Health Nurse Practitioner 363LA2200X AP119771 TX Primary

Addresses

Primary practice location

4500 S Lancaster Rd
Dallas, TX 75216-7167

Mailing address

4500 S Lancaster Rd
Dallas, TX 75216-7167
Phone (469) 797-2101

Other practice location 1

2201 SE Loop 820
Ft Worth, TX 76119-5863
Phone (469) 797-2101

Other identifiers 2

IdentifierTypeStateIssuer
P00943148OtherTXMEDICARE RAILROAD
352391YL7AOtherTXMEDICARE - OTHER COUNTY

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
I20211008002437 TX Order and Referring Only - Nurse Practitioner 2769668532

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP119771TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mid Cities Neurology Associates, P.a. CurrentSince May 13, 2013 Accepting new patients
Mary Snellings MD PLLC PastSince Aug 1, 2016 Accepting new patients

Locations

1305 Airport Fwy
Ste 205
Bedford, TX 76021
Phone (817) 267-6290

4525 Heritage Trace Pkwy
Ste 117
Fort Worth, TX 76244
Phone (817) 267-6290

Organizations & group practices 2

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": "1297728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1982901781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752167167",
            "telephone_number": "469-797-2101",
            "fax_number": "817-730-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 S LANCASTER RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752167167",
            "telephone_number": "469-797-2101",
            "fax_number": "817-730-0510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 SE Loop 820",
            "address_purpose": "LOCATION",
            "city": "Ft Worth",
            "state": "TX",
            "postal_code": "761195863",
            "country_code": "US",
            "telephone_number": "469-797-2101",
            "fax_number": "817-730-0510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAABE",
        "first_name": "ADRIAN",
        "middle_name": "JANE",
        "credential": "AGPCNP-BC, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-15",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP119771",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP119771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00943148",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - OTHER COUNTY",
            "identifier": "352391YL7A",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.