Northstar Internal Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

N5288 Issued in TX

Legal business name

NORTHSTAR INTERNAL MEDICINE PA

Practice address

5720 Appalossa Dr
Grand Prairie, TX 75052-2522

Phone

(817) 717-1299

NPI assigned

Oct 17, 2012

Organization subpart

No

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

Authorized official

Name

Ikechukwu A Nwabude, MDNPI 1720225816

Title

President and Ceo

Phone

(469) 209-9110

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ikechukwu A Nwabude, MD

  • Internal Medicine Physician
  • Grand Prairie, TX
  • NPI 1720225816
  Medicare reassignment NPD Authorized official
• Roseline A Jones, FNP-C

  • Family Nurse Practitioner
  • Rowlett, TX
  • NPI 1538645510
  Medicare reassignment NPD

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1992058705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 APPALOSSA DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750522522",
            "telephone_number": "469-209-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 APPALOSSA DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750522522",
            "telephone_number": "817-717-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "NWABUDE",
        "authorized_official_first_name": "IKECHUKWU",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "469-209-9110",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N5288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS LICENSE",
            "identifier": "N5288",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• North Texas Urgent Care, P.a.
• Frederick Frank Novak, DDS
• Zina M Novel, RPH
• Novell Home Health
• Andrea Dawn Novotny, PHARMD, RPH
• Brittanie Elizabeth Nunn, LVN

• Internal Medicine Physician in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.