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DESTINY IBROM FNP
NPI 1487153573
Nurse Practitioner - Family in Port Lavaca, TX

Active since February 05, 2018PECOS Enrolled
1200 N VIRGINIA ST, PORT LAVACA, TX 77979(361) 552-6721 Get Directions Write a Review

NPPES record last updated: November 1, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 1, 2019, Jan 7, 2019, Jun 11, 2018 (3 updates tracked since 2018).

About Destiny Ibrom Fnp NPPES

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

DESTINY IBROM FNP (NPI 1487153573) is an individual family provider in Port Lavaca, Texas, licensed in Texas (AP136422) and active in the NPI registry since February 2018. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1487153573
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameDESTINY IBROMCredential: FNP
Location Address1200 N VIRGINIA STPort Lavaca, TX 77979-2507
Mailing Address1200 N Virginia StPort Lavaca, TX 77979-2507
Phone(361) 552-6721
Sole ProprietorNo
Enumeration DateFebruary 5, 2018
Last NPPES UpdateNovember 1, 20193 updates tracked since enumeration
✔ NPI 1487153573 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in TX · AP136422
1200 N VIRGINIA ST, Port Lavaca, TX 77979
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Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Destiny Ibrom Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Destiny Ibrom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Port Lavaca Clinic Associates PA
Same address
Family Medicine
1200 NORTH VIRGINIA
Port Lavaca, TX 77979
  • Reassigned Medicare billing, Texas enrollment
  • 10 clinicians in this Medicare group
NPI 1144262957 (361) 552-6721

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 77979 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TIMU NIRATSUWAN KWI MD
Family Medicine
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 552-6721
JOHN WILLIAM CLINTON III M.D.
Pediatrics
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 522-6721
MICHAEL CAUGHRON FNP-C
Nurse Practitioner (Family)
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 552-6721
VICTORIA LEIGH BROWN FNP-C
Nurse Practitioner (Family)
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 552-6721
LEIGH ANN FALCON M.D.
Internal Medicine
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 552-6721
DR. KENNETH STEPHEN ROCA MD
Family Medicine
1200 N VIRGINIA ST
PORT LAVACA, TX 77979
Calhoun County (361) 552-6721

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 Destiny Ibrom's NPI number?

The NPI number for Destiny Ibrom is 1487153573. It was assigned to this individual provider in the NPPES registry on February 5, 2018.

Where is Destiny Ibrom located?

Destiny Ibrom practices at 1200 N Virginia St, Port Lavaca, TX 77979. The listed phone number is (361) 552-6721.

What is Destiny Ibrom's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Destiny Ibrom enrolled in Medicare?

Yes. Destiny Ibrom is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Destiny Ibrom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Destiny Ibrom reassigns Medicare benefits to Port Lavaca Clinic Associates PA (Port Lavaca, TX). The 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 Destiny Ibrom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Destiny Ibrom accept?

Health plans from UnitedHealthcare list Destiny Ibrom 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 Destiny Ibrom was last updated on November 1, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.