Individual provider Active NPI

Kaylie E Thomas, PA-C

  • Physician Assistant
  • Bryan, TX
National Provider Identifier
1083262380
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA13670 Issued in TX
Practice address
2801 Franciscan Dr
Bryan, TX 77802-2544
Phone
(979) 776-5967
Fax
(979) 731-5916
NPI assigned
Aug 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 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 PA13670 TX Primary

Addresses

Primary practice location

2801 Franciscan Dr
Bryan, TX 77802-2544

Mailing address

2801 Franciscan Dr
Bryan, TX 77802-2544
Phone (979) 776-3777

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (774) 441-6767

Other identifiers 1

IdentifierTypeStateIssuer
413042901MedicaidTX

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
I20200623000813 TX Practitioner - Physician Assistant 5698107951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Regional Health CenterGroup PAC ID 5294727921, 141 clinicians

Practice addresses (Care Compare)

1604 Rock Prairie Rd
College Station, TX 77845-8343
Phone (979) 764-5100

2801 Franciscan Dr
Bryan, TX 77802-2544
Phone (979) 776-2401

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA13670TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Regional Health Center CurrentSince Aug 3, 2020 Accepting new patients
St. Joseph Regional Health Center Physician Assistant CurrentSince Aug 3, 2020 Accepting new patients

Locations

2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777

Interoperability endpoints

  • Direct secure messaging: kthomas458646@direct.stlukeshealth.org

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1083262380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 FRANCISCAN DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022544",
            "telephone_number": "979-776-3777",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 FRANCISCAN DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022544",
            "telephone_number": "979-776-5967",
            "fax_number": "979-731-5916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "774-441-6767",
            "fax_number": "508-334-6490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KAYLIE",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA13670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413042901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.