Arianne Cunanan
Individual provider Active NPI Physician Assistant · Ennis, TX
NPI 1093189474 · NPPES record last updated Aug 3, 2016
Key facts
- NPI
- 1093189474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA10085 (TX)
- Practice address
- 601 S Clay St
#101
Ennis, TX 75119-5771 - Phone
- (972) 875-5220
- NPI assigned
- Nov 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Texas Medical Branch at Galveston, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
601 S Clay St
Suite 101
Ennis, TX 75119-5771
8400 NW 33Rd St
Suite 201
Doral, FL 33122-1937
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220224000562 | TX | Practitioner - Physician Assistant | 7214321884 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10085 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emmanuel E Sackey MD, PA | Past | Accepting new patients |
Interoperability endpoints
- acunanan25641@innovista.gardenplot.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10085 | TX | Yes |
Addresses
Primary practice location
601 S Clay St
#101
Ennis, TX 75119-5771
Mailing address
601 S Clay St
#101
Ennis, TX 75119-5771
Other providers in Ennis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.