Micah Christian Bowman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2419 W Southlake Blvd Ste 100
Southlake, TX 76092-1506

Phone

(469) 535-6842

NPI assigned

May 13, 2020

Last updated

Apr 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

University of North Texas HSC, College of Osteopathic Med, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Doctx3 PLLCGroup PAC ID 1355620055, 85 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Doctx3 PLLC

  • Orthopaedic Surgery Physician
  • Irving, TX
  • NPI 1467808618
  Medicare reassignment Care Compare group NPD
• Doctx3 PLLC

  • Clinic/Center
  • Mansfield, TX
  • NPI 1437802097
  NPD
• Doctx3 PLLC

  • Clinic/Center
  • Irving, TX
  • NPI 1316481724
  NPD (past)
• Dr Ben Deheshi Orthopedics PLLC

  • Clinic/Center
  • Fort Worth, TX
  • NPI 1992263628
  NPD (past)

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1013539998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2419 W SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921506",
            "telephone_number": "817-809-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 W SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921506",
            "telephone_number": "469-535-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "MICAH",
        "middle_name": "CHRISTIAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-13",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boulevard Diagnostic Management Group, LLC
• Boulevard Diagnostic MGMT Group
• Elizabeth Marie Bourg, DPT
• Angela G Bowers, M.D.
• Erin Bowers, OTR/L
• Sarah Lois Boykin
• Brace a-Cross LLC
• Niya Brackett, PT, DPT
• Aurora Bradford
• Leda Isabel Brady, DDS

• Physician Assistant in Southlake, TX
• Providers in Southlake, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.