Individual provider Active NPI

Nikole R Otahal, PA-C

  • Physician Assistant
  • Corpus Christi, TX
National Provider Identifier
1063989689
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12349 Issued in TX
Practice address
5917 Crosstown Expressway SH 286
Corpus Christi, TX 78417
Phone
(361) 854-0811
NPI assigned
Nov 1, 2018
Last updated
Feb 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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 PA12349 TX Primary

Addresses

Primary practice location

5917 Crosstown Expressway SH 286
Corpus Christi, TX 78417

Mailing address

230 County Road 3101
Orange Grove, TX 78372-9681
Phone (210) 835-8451

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
I20210719001815 TX Practitioner - Physician Assistant 2961805668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Texas Medical Branch at Galveston, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shea Physical Therapy Specialists LLCGroup PAC ID 6204245194, 194 clinicians

Practice addresses (Care Compare)

5440 Everhart Rd
Suite 1
Corpus Christi, TX 78411-4838
Phone (361) 994-5224

5917 Crosstown Epwy
SH 286
Corpus Christi, TX 78417-3504
Phone 3618541454113

5917 Crosstown Epwy SH
Suite 286
Corpus Christi, TX 78417-3504

5917 Crosstown Expy
Corpus Christi, TX 78417-3504

7121 S Padre Island Dr
Suite 306
Corpus Christi, TX 78412-4941
Phone (361) 854-0811

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.43 of 100Reported as group
Quality
76.55
Promoting interoperability
96
Improvement activities
40
Cost
58.22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Associates of Corpus Christi Physician Assistant CurrentSince Aug 2, 2021 Accepting new patients
Orthopedic Associates of Corpus Christi CurrentSince Aug 2, 2021 Accepting new patients
South Padre Island Pediatric Center Past Accepting new patients

Locations

5917 Crosstown Expy
#286
Corpus Christi, TX 78417
Phone (361) 854-1454

601 Texan Trl
Ste 300
Corpus Christi, TX 78411
Phone (361) 887-2900

Interoperability endpoints

  • Direct secure messaging: nikole.otahal.1@15288.direct.athenahealth.com

Organizations & group practices 4

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 3

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": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1063989689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 COUNTY ROAD 3101",
            "city": "ORANGE GROVE",
            "state": "TX",
            "postal_code": "783729681",
            "telephone_number": "210-835-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5917 CROSSTOWN EXPRESSWAY SH 286",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "78417",
            "telephone_number": "361-854-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTAHAL",
        "first_name": "NIKOLE",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-01",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.