Individual provider Active NPI

Henry Waters Jr., P.A.-C

  • Medical Physician Assistant
  • Wimberley, TX
National Provider Identifier
1003868738
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA03888 Issued in TX
Practice address
14100 Ranch Road 12
Ste 900
Wimberley, TX 78676-5354
Phone
(512) 847-3366
Fax
(512) 847-3327
NPI assigned
May 17, 2006
Last updated
Sep 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA03888 TX Primary

Addresses

Primary practice location

14100 Ranch Road 12
Ste 900
Wimberley, TX 78676-5354

Mailing address

PO Box 2970
Wimberley, TX 78676-7870
Phone (512) 847-3366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040616001263 TX Practitioner - Physician Assistant 1850375841 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11282 Culebra Rd
Suite 115
San Antonio, TX 78253-7329
Phone (210) 802-2660

1211 Austin Hwy
Suite 110
San Antonio, TX 78209-4980
Phone (210) 774-5010

1240 E Palm Valley Blvd
Round Rock, TX 78664-3202
Phone (512) 733-9100

16755 Huebner Rd
San Antonio, TX 78248-2342
Phone (210) 493-4357

7110 FM
78 Suite 110
San Antonio, TX 78244-1765
Phone (210) 310-2273

791 FM
1103 Suite 125
Cibolo, TX 78108-3673
Phone (830) 240-2615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA03888TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ucp Physicians of Central Texas, PLLC CurrentSince Mar 7, 2016 Accepting new patients
Leading Edge Emergency Physicians, Inc CurrentSince Jan 23, 2017 Accepting new patients
Wimberley Valley Medical Center LP Past Accepting new patients
Third Coast Emergency Physicians Sid Peterson PA Past Accepting new patients

Locations

6001 W William Cannon Dr
Ste 302
Austin, TX 78749
Phone (512) 288-3627

1331 Northpark Dr
Kingwood, TX 77339
Phone (281) 359-5330

1240 E Palm Valley Blvd
Round Rock, TX 78664
Phone (512) 733-9100

16088 San Pedro Ave
San Antonio, TX 78232
Phone (210) 402-4092

16755 Huebner Rd
San Antonio, TX 78248
Phone (210) 493-4357

Interoperability endpoints

  • Direct secure messaging: henry.waterspac.p6@direct.nextcare.nextgenshare.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220918400000",
    "number": "1003868738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2970",
            "city": "WIMBERLEY",
            "state": "TX",
            "postal_code": "786767870",
            "telephone_number": "512-847-3366",
            "fax_number": "512-847-3327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 RANCH ROAD 12",
            "address_2": "STE 900",
            "city": "WIMBERLEY",
            "state": "TX",
            "postal_code": "786765354",
            "telephone_number": "512-847-3366",
            "fax_number": "512-847-3327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "HENRY",
        "name_suffix": "Jr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wimberley, TX

Sources for this page

Verify at the official NPI Registry.