Individual provider Active NPI

Samuel Anene, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1093685299
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19956 Issued in TX
Practice address
1411 N Beckley Ave Ste 352
Dallas, TX 75203-1270
Phone
(469) 981-2648
Fax
(469) 981-2649
NPI assigned
Nov 11, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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 PA19956 TX Primary

Addresses

Primary practice location

1411 N Beckley Ave Ste 352
Dallas, TX 75203-1270

Mailing address

1411 N Beckley Ave Ste 352
Dallas, TX 75203-1270
Phone (469) 981-2648

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
I20260424001363 TX Practitioner - Physician Assistant 2163999343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1411 N Beckley Ave
Suite 352
Dallas, TX 75203-1270

PO Box
Suite 2736
Desoto, TX 75123

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA19956TXMDPhysician Assistant

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HJGHCD/Endpoint/HJGHCD

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1762819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1093685299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 N BECKLEY AVE STE 352",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031270",
            "telephone_number": "469-981-2648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 N BECKLEY AVE STE 352",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031270",
            "telephone_number": "469-981-2648",
            "fax_number": "469-981-2649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANENE",
        "first_name": "SAMUEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-11",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA19956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.