Soumana Djibo, in Southlake, TX - Medicare Nurse Practitioner

Soumana Djibo, is a medicare enrolled "Nurse Practitioner - Family" in Southlake, Texas. His current practice location is 855 Davis Blvd, Southlake, Texas. You can reach out to his office (for appointments etc.) via phone at (817) 912-1771.

Soumana Djibo is licensed to practice in Texas (license number AP141893) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1760148753.

Contact Information

	Soumana Djibo,
	855 Davis Blvd, Southlake, TX 76092-8244
	(817) 912-1771
	Not Available

Map and Direction

Provider's Profile

Full Name	Soumana Djibo
Gender	Male
Speciality	Nurse Practitioner - Family
Location	855 Davis Blvd, Southlake, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1760148753
Provider Enumeration Date: 11/13/2021
Last Update Date: 10/31/2022

Medicare PECOS Information:

PECOS PAC ID: 1658757588
Enrollment ID: I20220930000026

Medical Identifiers

Medical identifiers for Soumana Djibo such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1760148753	NPI	-	NPPES
1760148753	Medicaid	TX

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	AP141893 (Texas)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Soumana Djibo allows following entities to bill medicare on his behalf.

Entity Name	Modern Medical House Calls Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1043635931 PECOS PAC ID: 5092932921 Enrollment ID: O20140815001827

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Soumana Djibo is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Soumana Djibo, 3402 Rosemead Dr, Arlington, TX 76014-3557 Ph: () -	Soumana Djibo, 855 Davis Blvd, Southlake, TX 76092-8244 Ph: (817) 912-1771

Reviews and Comments

Nurse Practitioner Nurses in Southlake, TX

Carmen Santiago, APRN-CNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1110 N Carroll Ave, Southlake, TX 76092 Phone: 817-310-1100 Fax: 817-310-1197
Nikita Greenwood, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1920 E State Highway 114, Southlake, TX 76092 Phone: 817-442-5698
Janice F Rubbelke, FNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 601 E Southlake Blvd, Suite 200, Southlake, TX 76092 Phone: 817-488-1956 Fax: 817-488-8675
Mona Lisa Jimenez, PMHNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 431 E State Highway 114 Fl 1, Southlake, TX 76092 Phone: 844-824-8775
Britney Molini, APRN Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1050 E State Highway 114 Ste 100, Southlake, TX 76092 Phone: 817-329-8364
Andrew Sadousky, MS, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 250 Miron Dr, Southlake, TX 76092 Phone: 817-328-3000
Pete C Bravo Jr., FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2777 E Southlake Blvd Ste 140, Southlake, TX 76092 Phone: 817-686-8104

Soumana Djibo, - Medicare Nurse Practitioner in Southlake, TX