Individual provider Active NPI

Manuel Hernandez, P.A

  • Physician Assistant
  • Eagle Pass, TX
National Provider Identifier
1063805935
Registry record updated Mar 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA09609 Issued in TX
Practice address
290 Jefferson St
Eagle Pass, TX 78852-4820
Phone
(830) 773-3331
Fax
(830) 773-2981
NPI assigned
Mar 16, 2015
Last updated
Mar 16, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA09609 TX Primary

Addresses

Primary practice location

290 Jefferson St
Eagle Pass, TX 78852-4820

Mailing address

290 Jefferson St
Eagle Pass, TX 78852-4820
Phone (830) 773-3331

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
I20150413002149 TX Practitioner - Physician Assistant 8921326414 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2824 N Veterans Blvd
Suite a
Eagle Pass, TX 78852-6695
Phone (830) 757-4900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA09609TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Maverick County Hospital District CurrentSince Feb 10, 2025 Accepting new patients
Maverick County Hospital District CurrentSince Feb 10, 2025 Accepting new patients

Locations

2824 N Veterans Blvd
Ste A
Eagle Pass, TX 78852
Phone (830) 213-8815

3406 Bob Rogers Dr
Ste 120
Eagle Pass, TX 78852
Phone (830) 757-4570

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1063805935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 JEFFERSON ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788524820",
            "telephone_number": "830-773-3331",
            "fax_number": "830-773-2981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 JEFFERSON ST",
            "city": "EAGLE PASS",
            "state": "TX",
            "postal_code": "788524820",
            "telephone_number": "830-773-3331",
            "fax_number": "830-773-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "MANUEL",
        "name_prefix": "Mr.",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-16",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle Pass, TX

Sources for this page

Verify at the official NPI Registry.