Dr. Rafael J. Rafols
- Gender: Male
- Experience: 17 years
- Graduation year: 2004
- Sole propriator: No
- NPI: 1609028612
Dr. Rafael J. Rafols M.D.
Family Physician
He is located at 5509 Doctors Drive in Edinburg, TX 78539. Can help patients with the following: Autism, Breastfeeding and Lactation, Common Cold, Hypothyroidism, Osteoporosis, Women's Health. His National Provider Identifier (NPI) number is 1609028612. Appointment can be made via the phone number (956) 362-5525. He is affiliated with 1 practices and 3 hospitals.
Conditions treated
Dr. Rafael J. Rafols, being an family physician, treats the following conditions. Please be advised that this list may not be complete. For the full list of conditions treated, consult directly with Dr. Rafael J. Rafols.
- Abdominal Pain
- Aging In Place
- Anxiety
- Arthritis
- Asthma
- Autism
- Birth Control Counseling
- Breastfeeding and Lactation
- Chronic Obstructive Pulmonary Disease (COPD)
- Common Cold
- Diabetes
- Fever
- General Care
- Headache
- Heart Disease
- High Blood Pressure
- Hyperlipidemia
- Hypothyroidism
- Infant Care
- Influenza
- Migraine
- Mold Exposure
- Nausea and Vomiting
- Obesity
- Osteoarthritis (OA)
- Osteoporosis
- Pregnancy
- Prenatal Care
- Prescription Refill
- Thyroid Disease
- Women's Health
Procedures Performed by Dr. Rafael J. Rafols
ACA Marketplace (Obamacare/HealthCare.gov) plan networks
Insurers selling ACA Marketplace (HealthCare.gov) plans list Dr. Rafael J. Rafols as in-network for the following 2026 plans.
Health plans
Ambetter from Superior HealthPlan
Network data as of Sep 15, 2026, as reported by the insurer.
Show all 12 plans from Ambetter from Superior HealthPlan
| Plan | Plan type | Network tier | New patients |
|---|---|---|---|
| Complete Gold | EPO · Gold | Preferred | Accepting new patients at some locations |
| Complete Gold + Vision + Adult Dental | EPO · Gold | Preferred | Accepting new patients at some locations |
| Enhanced Diabetes Care Silver with $0 Drug Options | EPO · Silver | Preferred | Accepting new patients at some locations |
| Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental | EPO · Silver | Preferred | Accepting new patients at some locations |
| Everyday Gold | EPO · Gold | Preferred | Accepting new patients at some locations |
| Everyday Gold + Vision + Adult Dental | EPO · Gold | Preferred | Accepting new patients at some locations |
| Focused Silver | EPO · Silver | Preferred | Accepting new patients at some locations |
| Focused Silver + Vision + Adult Dental | EPO · Silver | Preferred | Accepting new patients at some locations |
| Standard Gold | EPO · Gold | Preferred | Accepting new patients at some locations |
| Standard Gold + Vision + Adult Dental | EPO · Gold | Preferred | Accepting new patients at some locations |
| Standard Silver | EPO · Silver | Preferred | Accepting new patients at some locations |
| Standard Silver + Vision + Adult Dental | EPO · Silver | Preferred | Accepting new patients at some locations |
Blue Cross and Blue Shield of Texas
Network data as of Jun 7, 2026, as reported by the insurer.
Show all 19 plans from Blue Cross and Blue Shield of Texas
| Plan | Plan type | Network tier | New patients |
|---|---|---|---|
| Blue Advantage Bronze HMO℠ 204 (27 plan variants) | HMO · Expanded Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Bronze HMO℠ 301 (14 plan variants) | HMO · Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Bronze HMO℠ Standard (27 plan variants) | HMO · Expanded Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Gold HMO℠ 206 (27 plan variants) | HMO · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Gold HMO℠ 603 (14 plan variants) | HMO · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Gold HMO℠ Standard (27 plan variants) | HMO · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Bronze℠ 303 (27 plan variants) | POS · Expanded Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Bronze℠ 305 (27 plan variants) | POS · Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Bronze℠ Standard (27 plan variants) | POS · Expanded Bronze | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Gold℠ 203 (27 plan variants) | POS · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Gold℠ 803 (27 plan variants) | POS · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Gold℠ Standard (27 plan variants) | POS · Gold | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Silver℠ 202 (27 plan variants) | POS · Silver | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Silver℠ 605 (27 plan variants) | POS · Silver | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Plus Silver℠ Standard (27 plan variants) | POS · Silver | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Security HMO℠ 200 (27 plan variants) | HMO · Catastrophic | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Silver HMO℠ 205 (27 plan variants) | HMO · Silver | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Silver HMO℠ 801 (14 plan variants) | HMO · Silver | Blue Advantage HMO | Accepting new patients |
| Blue Advantage Silver HMO℠ Standard (27 plan variants) | HMO · Silver | Blue Advantage HMO | Accepting new patients |
UnitedHealthcare
Network data as of Sep 15, 2026, as reported by the insurer.
Show all 14 plans from UnitedHealthcare
| Plan | Plan type | Network tier | New patients |
|---|---|---|---|
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) | HMO · Expanded Bronze | Non Preferred | Accepting new patients |
| UHC Bronze Essential ($0 Virtual Urgent Care) | HMO · Bronze | Non Preferred | Accepting new patients |
| UHC Bronze Standard | HMO · Expanded Bronze | Non Preferred | Accepting new patients |
| UHC Bronze Standard+ (Dental + Vision) | HMO · Expanded Bronze | Non Preferred | Accepting new patients |
| UHC Gold Advantage ($0 Virtual Urgent Care, $8 Tier 2 Rx) | HMO · Gold | Non Preferred | Accepting new patients |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $8 Tier 2 Rx, Dental + Vision) | HMO · Gold | Non Preferred | Accepting new patients |
| UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx) | HMO · Gold | Non Preferred | Accepting new patients |
| UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $8 Tier 2 Rx, Dental + Vision) | HMO · Gold | Non Preferred | Accepting new patients |
| UHC Gold Standard | HMO · Gold | Non Preferred | Accepting new patients |
| UHC Silver Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx) | HMO · Silver | Non Preferred | Accepting new patients |
| UHC Silver Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision) | HMO · Silver | Non Preferred | Accepting new patients |
| UHC Silver Standard | HMO · Silver | Non Preferred | Accepting new patients |
| UHC Silver Value ($0 Virtual Urgent Care) | HMO · Silver | Non Preferred | Accepting new patients |
| UHC Silver Value+ ($0 Virtual Urgent Care, Dental + Vision) | HMO · Silver | Non Preferred | Accepting new patients |
This covers ACA Marketplace plans only, as reported by each insurer. It does not include employer, Medicare Advantage, or state-run exchange plans, and a plan missing from this list does not mean Dr. Rafael J. Rafols is out of network. Insurer directories can be out of date, so always confirm with the insurer and the office before your visit.
Medicare Enrollment
Dr. Rafael J. Rafols is enrolled to bill Medicare as a Practitioner - Family Practice .
Bills through: Rafael Rafols Md Pa
Based on Medicare's public enrollment records as of Jul 17, 2026. This reflects Medicare fee-for-service enrollment only and says nothing about other insurance, quality, outcomes, or board certification.
Payments received
Drug payment
| Smith \u0026 Nephew | $2017 |
| KCI USA | $2000 |
| Osiris Therapeutics | $1545 |
Other
| Food and Beverage | $5043 |
| Consulting | $2000 |
| Other | $500 |
Studies
Graduated in 2004Sanctions
| Date | Description | Board |
|---|---|---|
| 04/13/2012 | 13059.0 - RM 164.053(a)(1) VIOLATION OF LAWS CONNECTED WITH PRACTICE OF MEDICINE | Medical Board |
Affiliated hospitals
Looking for more Family Physicians?
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- Address: 4745 South Jackson Road Edinburg, 78539, TX
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- Address: 5501 South Mccoll Road Edinburg, 78539, TX
- Gender: Male
- Address: 2808 Fountain Plaza Boulevard Edinburg, 78539, TX
- Gender: Male
- Address: 5509 Doctors Drive Edinburg, 78539, TX
- Gender: Female
- Address: 11006 Spencer Highway La Porte, 77571, TX
- Gender: Male
- Address: 5501 South Mccoll Road Edinburg, 78539, TX
- Gender: Female
- Address: 1400 South Closner Boulevard Edinburg, 78539, TX
- Gender: Male
- Address: 102 West Main Street Wallace, 28466, NC
Questions & Answers
Has Dr. Rafael J. Rafols affiliation with hospitals?
Dr. Rafael J. Rafols is affiliated with SOUTH TEXAS HEALTH SYSTEM. For the full list of hospitals see this list.
Does Dr. Rafael J. Rafols accept patients with Ambetter from Superior HealthPlan?
Yes, Dr. Rafael J. Rafols is listed in-network for Ambetter from Superior HealthPlan through the ACA Marketplace (Obamacare/HealthCare.gov). See the Marketplace plans section for details.
Where can you meet with Dr. Rafael J. Rafols?
Dr. Rafael J. Rafols's office is located at 5509 Doctors Drive in Edinburg, TX 78539.
What conditions does Dr. Rafael J. Rafols treat?
Dr. Rafael J. Rafols provides treatment for Autism, Breastfeeding and Lactation, Common Cold, Hypothyroidism, Osteoporosis, Women's Health. For the full list see this list.
Does Dr. Rafael J. Rafols have affiliation with practices?
Dr. Rafael J. Rafols is affiliated with Rafael Rafols MD PA.