Individual provider Active NPI

Loralyn H Logan, PA

  • Medical Physician Assistant
  • Houston, TX
National Provider Identifier
1174550370
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA04753 Issued in TX
Practice address
710 FM 1960 Rd
Houston, TX 77090-3402
Phone
(281) 440-2543
NPI assigned
Jun 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA04753 TX Primary
Physician Assistant 363A00000X PA04753 TX

Addresses

Primary practice location

710 FM 1960 Rd
Houston, TX 77090-3402

Mailing address

710 FM 1960 Rd
Houston, TX 77090-3402
Phone (281) 440-2543

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
I20060921000478 TX Practitioner - Physician Assistant 0941205157 Reassigns benefits to 5 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA04753TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Next Level MV LLC CurrentSince Jul 2, 2018 Accepting new patients
Nluc PLLC CurrentSince Jul 2, 2018 Accepting new patients
Nluc PLLC CurrentSince Jul 2, 2018 Accepting new patients
Brazos Emergency Physicians, PA Past Accepting new patients
Methodist Health Centers Past Accepting new patients
Cypress Emergency Associates PA Past Accepting new patients

Locations

1246 N FM 3083 Rd W
Ste B
Conroe, TX 77304

8325 Broadway St
Ste 220
Pearland, TX 77581
Phone (281) 873-8162

16312 Southwest Fwy
Ste 18
Sugar Land, TX 77479

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349222400000",
    "number": "1174550370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 FM 1960 RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770903402",
            "telephone_number": "281-440-2543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FM 1960 RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770903402",
            "telephone_number": "281-440-2543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "LORALYN",
        "middle_name": "H",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2012-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA04753",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04753",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.