Wildon Mellinger Rouse III

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02598 Issued in TX

Practice address

1253 N Von Minden St
La Grange, TX 78945-1262

Phone

(979) 968-8493

Fax

(979) 968-6388

NPI assigned

Apr 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

McBroom Clinic PAGroup PAC ID 5890893119, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elara Caring Home health agency, Round Rock, TX, CCN 457661
• Columbus Community Hospital Hospital, Columbus, TX, CCN 450370
• Lavaca Medical Center Hospital, Hallettsville, TX, CCN 451376

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: wildon.rouse.1@19983.direct.athenahealth.com

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

• McBroom Clinic PA

  • Family Medicine Physician
  • La Grange, TX
  • NPI 1114088093
  Medicare reassignment Care Compare group
• LGFM PLLC

  • Family Medicine Physician
  • La Grange, TX
  • NPI 1871153775
  Medicare reassignment
• South Texas Medical Clinics, P.a.

  • General Practice Physician
  • East Bernard, TX
  • NPI 1114077427
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Columbus Community Hospital

  • Rural Acute Care Hospital
  • Columbus, TX
  • NPI 1740238641
  Care Compare affiliation
• Lavaca Hospital District

  • Critical Access Hospital
  • Hallettsville, TX
  • NPI 1992767511
  Care Compare affiliation
• Texas Home Healthcare Partners, LP

  • Home Health Agency
  • Round Rock, TX
  • NPI 1174569628
  Care Compare affiliation

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386115200000",
    "number": "1003873845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1253 N VON MINDEN ST",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789451262",
            "telephone_number": "979-968-8493",
            "fax_number": "979-968-6388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 N VON MINDEN ST",
            "city": "LA GRANGE",
            "state": "TX",
            "postal_code": "789451262",
            "telephone_number": "979-968-8493",
            "fax_number": "979-968-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSE",
        "first_name": "WILDON",
        "middle_name": "MELLINGER",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2013-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "MDF1715TX",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "308464202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS #",
            "identifier": "875N33",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00477542",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Blauert Reilly, CRNA, DNP
• Reagan Renee Richter, FNP-C
• Robert H Smalley Mdpa
• Karen A Roberts, DDS
• Amanda Rosenauer, CFNP
• Rachel Russo
• Sage Professional Consulting Corporation
• Schroeder Drug
• Tina Folse Schultis, RN,CNOR,RNFA
• Shannon M Juno M.D. P.a.

• Physician Assistant in La Grange, TX
• Providers in La Grange, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.