| MD Trucare PA | |
|
823 Ira E Woods Ave Ste 200 Grapevine TX 76051-4096 | |
| (817) 722-6078 | |
| (817) 722-6077 |
| Full Name | MD Trucare PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 823 Ira E Woods Ave Ste 200, Grapevine, Texas |
| Authorized Official Name and Position | Ayesha Ebrahim (CEO) |
| Authorized Official Contact | 2182050198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| MD Trucare PA Po Box 93685 Southlake TX 76092-0116 Ph: (218) 205-0198 | MD Trucare PA 823 Ira E Woods Ave Ste 200 Grapevine TX 76051-4096 Ph: (817) 722-6078 |
| NPI Number | 1043754526 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 03/04/2022 |
| Certification Date | 03/04/2022 |
| Medicare PECOS PAC ID | 1557643467 |
|---|---|
| Medicare Enrollment ID | O20170127002129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043754526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | () | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Secondary |
| Provider Name | Tate Rubley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1619298403 PECOS PAC ID: 5799979696 Enrollment ID: I20101104001082 |
| Provider Name | Imran S Khawaja |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073509253 PECOS PAC ID: 0749190890 Enrollment ID: I20160302001333 |
| Provider Name | Ayesha Ebrahim |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1831144609 PECOS PAC ID: 3678587862 Enrollment ID: I20170130000235 |
| Provider Name | Dykstra Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578042727 PECOS PAC ID: 7810237112 Enrollment ID: I20190325000810 |
| Provider Name | Ayako Sugiyama |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871128157 PECOS PAC ID: 8022433663 Enrollment ID: I20200730000572 |
| Provider Name | Jennifer Chineme Adesina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265055511 PECOS PAC ID: 2860817103 Enrollment ID: I20200804002661 |
| Provider Name | Melissa Ann Tarver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972193035 PECOS PAC ID: 2264848415 Enrollment ID: I20210312000653 |
| Provider Name | Jasey Kelne Patterson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578130811 PECOS PAC ID: 7416350442 Enrollment ID: I20210728000800 |
| Provider Name | Aileen Fisher |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1881783876 PECOS PAC ID: 1658564398 Enrollment ID: I20210813002328 |
| Provider Name | Hannah Collins Kircher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487302931 PECOS PAC ID: 2062894215 Enrollment ID: I20220804000108 |
| Provider Name | Damian Hooker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972210870 PECOS PAC ID: 0446628796 Enrollment ID: I20221117003375 |
| Provider Name | Bernadette Okpei |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1699490250 PECOS PAC ID: 3678941762 Enrollment ID: I20221121002914 |
| Provider Name | Stephanie Renee Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669195848 PECOS PAC ID: 1557731155 Enrollment ID: I20221222001500 |
| Provider Name | Vivek Poudel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407581283 PECOS PAC ID: 2567832934 Enrollment ID: I20221229000138 |
| Provider Name | Sarah Enchautegui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538840897 PECOS PAC ID: 2466814975 Enrollment ID: I20230816000530 |
| Provider Name | Maryam Sajjad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144954959 PECOS PAC ID: 5496104028 Enrollment ID: I20231207004070 |
| Provider Name | Naomi Lue Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740063544 PECOS PAC ID: 3577901990 Enrollment ID: I20240404001957 |
| Provider Name | Ikra Ashrafi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740996263 PECOS PAC ID: 1153863444 Enrollment ID: I20240531003792 |
| Provider Name | Linda Iyamah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346920485 PECOS PAC ID: 2264615921 Enrollment ID: I20240604004153 |
| Provider Name | Victor H. Estupinan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699559351 PECOS PAC ID: 0749724888 Enrollment ID: I20240701002180 |
| Provider Name | Caitlyn Krusinsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376388041 PECOS PAC ID: 9931644176 Enrollment ID: I20240712000743 |
| Provider Name | Vanessa Rotibi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679315543 PECOS PAC ID: 4082155775 Enrollment ID: I20240921000105 |
| Provider Name | Aanchal Rajagopal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609575455 PECOS PAC ID: 5890229454 Enrollment ID: I20241106000051 |
| Provider Name | Abosede Olubunmi Gbakinro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770330326 PECOS PAC ID: 9638314883 Enrollment ID: I20241218002380 |
| Provider Name | Nikita Dhungel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518781970 PECOS PAC ID: 2668901125 Enrollment ID: I20250128004953 |
| Provider Name | Shelton Brock Monroe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245023878 PECOS PAC ID: 4587175336 Enrollment ID: I20250618000744 |
| Provider Name | Smitha Syamala Komatreddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174413470 PECOS PAC ID: 3678089455 Enrollment ID: I20250718002582 |
| Provider Name | Anupa Dhital |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902796741 PECOS PAC ID: 2365958089 Enrollment ID: I20250721001767 |
| Provider Name | Penny Michele Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053947135 PECOS PAC ID: 5597252288 Enrollment ID: I20251015004640 |
| Provider Name | Hyun Jung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992656136 PECOS PAC ID: 6709366487 Enrollment ID: I20260212004512 |
| Provider Name | Hannah Hyden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265274690 PECOS PAC ID: 6002399359 Enrollment ID: I20260313003575 |
| Provider Name | Boone Martin Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881540052 PECOS PAC ID: 0648753764 Enrollment ID: I20260317000608 |
| Provider Name | Rita Vigil |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1427832435 PECOS PAC ID: 3577038900 Enrollment ID: I20260413003360 |
| Provider Name | Susan Kwamboka Mwembi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447188016 PECOS PAC ID: 3274003090 Enrollment ID: I20260521003103 |
Vhs Grapevine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2300 William D Tate Ave, Grapevine, TX 76051 Phone: 817-424-1305 Fax: 817-424-1327 |
Grapevine Medical & Surgical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 W Northwest Hwy, Grapevine, TX 76051 Phone: 817-481-5365 Fax: 817-424-3264 |
Brooks P. Trotter M.D. P.A. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1604 Lancaster Dr, Grapevine, TX 76051 Phone: 817-481-8661 Fax: 817-416-8801 |
Huned Husain MD PLLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 517 Chasewood Dr, Grapevine, TX 76051 Phone: 817-722-8852 |
Corvinus Medical Group LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4100 Heritage Ave, Suite 102, Grapevine, TX 76051 Phone: 817-271-4551 |
Inpatient Group of Grapevine MD PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1650 W College St # 57, Grapevine, TX 76051 Phone: 214-770-1182 Fax: 877-824-7861 |