Individual ProviderIngrid BocanegraFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address4800 Fournace Pl, Bellaire, TX 77401-2324(346) 426-0478(305) 915-3064PECOS EnrollmentBased on the most recent information from CMS, provider Ingrid Bocanegra is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1902125503Provider TypeIndividualFull NameBocanegra, IngridGenderFemaleSole ProprietorNoEnumeration Date5/20/2010Last Updated8/19/2022Contact InformationPractice LocationPractice Address4800 Fournace Pl, Bellaire, TX 77401-2324Phone(346) 426-0478FaxUnlisted FaxMailing LocationMailing AddressPO Box 270714, Houston, TX 77277-0714Phone(305) 915-3064FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseR0362TexasCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerIndianaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense01073251AIndianaProvider IdentifiersIDDescriptionIssuerID000000851833DescriptionOtherIssuerANTHEM PIN FOR FAMILY MEDICINE TIN 35-2030653IndianaID000000865042DescriptionOtherIssuerANTHEM URGENT CARE PIN FOR TIN 35-2030653IndianaID201093580DescriptionMedicaidIssuerUnlistedIndiana