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PRAJNAWATI WIBOWO NP
NPI 1760959696
Nurse Practitioner - Psychiatric/Mental Health in Dallas, TX

Active since October 29, 2018PECOS EnrolledAccepts Medicare Assignment
5301 ALPHA RD STE 80-3, DALLAS, TX 75240(682) 215-1691(682) 267-4840 Get Directions Write a Review

NPPES record last updated: October 27, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 7, 2023, Nov 22, 2022, Nov 10, 2022 and 4 more (7 updates tracked since 2018).

About Prajnawati Wibowo Np NPPES

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

PRAJNAWATI WIBOWO NP (NPI 1760959696) is an individual psychiatric/mental health provider in Dallas, Texas, licensed in Texas (AP139122) and active in the NPI registry since October 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1760959696
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NamePRAJNAWATI WIBOWOCredential: NP
Location Address5301 ALPHA RD STE 80-3Dallas, TX 75240-4355
Mailing Address5301 Alpha Rd Ste 80-3Dallas, TX 75240-4355 · (682) 215-1691 · Fax (682) 267-4840
Phone(682) 215-1691
Fax(682) 267-4840
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateOctober 29, 2018
Last NPPES UpdateOctober 27, 20257 updates tracked since enumeration
NPPES CertifiedOctober 27, 2025
✔ NPI 1760959696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Licenses✔ Licensed in TX · AP139122✔ Licensed in CA · 95034910
Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License AP139122 (TX)
5301 ALPHA RD STE 80-3, Dallas, TX 75240
Open in Google Maps ↗

Other Identifiers 3

OtherAP139122TX · License
Other95034910CA · License
OtherXW5044653TX · Data 2000 Waiver

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Prajnawati Wibowo Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2264862077
PECOS Enrollment IDI20200420000147
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75240 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
$88.19 typical visit price
range $57.18 – $172.86
Typical copayment $22.04 (range $14.29 – $43.21)
Most-billed visit code 99203
Established Patient
$100.80 typical visit price
range $18.48 – $141.20
Typical copayment $25.20 (range $4.62 – $35.30)
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

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

GRACE IN HEALINGS PLLC
Registered Nurse (Psychiatric/Mental Health)
5301 ALPHA RD STE 80-3
DALLAS, TX 75240
Dallas County (682) 215-1691

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 Prajnawati Wibowo's NPI number?

The NPI number for Prajnawati Wibowo is 1760959696. It was assigned to this individual provider in the NPPES registry on October 29, 2018.

Where is Prajnawati Wibowo located?

Prajnawati Wibowo practices at 5301 Alpha Rd Ste 80-3, Dallas, TX 75240. The listed phone number is (682) 215-1691.

What is Prajnawati Wibowo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Prajnawati Wibowo enrolled in Medicare?

Yes. Prajnawati Wibowo is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Prajnawati Wibowo accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 6 other insurers list Prajnawati Wibowo 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 Prajnawati Wibowo was last updated on October 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.