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VINE FAMILY MEDICINE PLLC
NPI 1407427420
Family Medicine in Keller, TX

Active since July 09, 2021CLIA 45D2235736 · Waiver
420 JOHNSON RD STE 304, KELLER, TX 76248(817) 710-3040(989) 200-4650 Get Directions Write a Review

NPPES record last updated: July 12, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 12, 2021, Jul 9, 2021 (2 updates tracked since 2021).

About Vine Family Medicine Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VINE FAMILY MEDICINE PLLC (NPI 1407427420) is a healthcare organization registered as a family medicine in Keller, Texas and active in the NPI registry since July 2021. The organization holds a CLIA Waiver certificate valid through September 9, 2027 and lists Ochuele Odumosu, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1407427420
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameVINE FAMILY MEDICINE PLLC
Location Address420 JOHNSON RD STE 304Keller, TX 76248-3463
Mailing Address420 Johnson Rd Ste 304Keller, TX 76248-3463 · (817) 710-3040 · Fax (989) 200-4650
Phone(817) 710-3040
Fax(989) 200-4650
Organization SubpartNo
Authorized OfficialOchuele OdumosuMedical Director · (817) 710-3040
Enumeration DateJuly 9, 2021
Last NPPES UpdateJuly 12, 20212 updates tracked since enumeration
NPPES CertifiedJuly 12, 2021
✔ NPI 1407427420 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
420 JOHNSON RD STE 304, Keller, TX 76248
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Vine Family Medicine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Vine Family Medicine PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Ochuele Odumosu, M.D.
Family Practice
NPI 1891079323
420 JOHNSON RD STE 304
Keller, TX 76248
(817) 710-3040
✔ PECOS✔ Accepts MedicareSame address
Oluwaseun Odumosu, MD
Family Practice
NPI 1356654909
420 JOHNSON RD STE 304
Keller, TX 76248
(817) 710-3040
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2235736

Vine Family Medicine · Keller, TX
Active · expires Sep 9, 2027
CLIA Number45D2235736
Laboratory TypePhysician Office
Certificate Effective DateSeptember 10, 2025
Certificate Expiration DateSeptember 9, 2027
Laboratory DirectorOchuele Odumosu
Laboratory Phone(817) 710-3040
Laboratory LocationVine Family Medicine420 Johnson Rd Suite 304, Keller, TX 76248
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vine Family Medicine PLLC's NPI number?

The NPI number for Vine Family Medicine PLLC is 1407427420. It was assigned to this organization in the NPPES registry on July 9, 2021.

Where is Vine Family Medicine PLLC located?

Vine Family Medicine PLLC is located at 420 Johnson Rd Ste 304, Keller, TX 76248. The listed phone number is (817) 710-3040.

What is Vine Family Medicine PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Vine Family Medicine PLLC enrolled in Medicare?

Yes. Vine Family Medicine PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Vine Family Medicine PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Vine Family Medicine PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Vine Family Medicine PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2235736) is associated with this NPI, valid through September 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Vine Family Medicine PLLC accept?

Health plans from Molina Healthcare list Vine Family Medicine PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Vine Family Medicine PLLC was last updated on July 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.