Individual provider Active NPI

Amye Suzette Lilljedahl, PA-C

  • Physician Assistant
  • Bellville, TX
National Provider Identifier
1174855183
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01100 Issued in TX
Practice address
235 W Palm St Ste 106
Bellville, TX 77418-1300
Phone
(979) 810-0575
Fax
(979) 810-0591
NPI assigned
Feb 2, 2010
Last updated
May 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

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 PA01100 TX Primary

Addresses

Primary practice location

235 W Palm St Ste 106
Bellville, TX 77418-1300

Mailing address

235 W Palm St Ste 105
Bellville, TX 77418-1300
Phone (979) 865-3124

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
I20130419000438 TX Practitioner - Physician Assistant 4880830785 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

17510 W Grand Pkwy S
Sugar Land, TX 77479-2649

235 W Palm St
Bellville, TX 77418-1300
Phone (979) 272-4156

7900 Fannin St
Suite 4000
Houston, TX 77054-2935
Phone (713) 512-7500

8215 Cypresswood Dr
Spring, TX 77379-7466
Phone (832) 717-0877

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125358TXMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
El Campo Memorial Hospital CurrentSince Jan 1, 2023 Accepting new patients
Privia Medical Group Gulf Coast, PLLC CurrentSince Apr 18, 2025 Accepting new patients
Scott & White Clinic CurrentSince Aug 7, 2018 Accepting new patients

Locations

235 W Palm St
Ste 105
Bellville, TX 77418
Phone (409) 861-0100

235 W Palm St
Ste 106
Bellville, TX 77418
Phone (979) 272-4156

600 N Park St
Brenham, TX 77833
Phone (409) 836-6153

3201 University Dr E
Ste 200
Bryan, TX 77802
Phone (979) 268-7914

1280 Arrington Rd
Ste 200
College Station, TX 77845
Phone (979) 207-6550

646 FM 517 Rd W
Dickinson, TX 77539
Phone (281) 309-9001

303 Sandy Corner Rd
El Campo, TX 77437
Phone (979) 543-6251

1200 Binz St
Ste 1490
Houston, TX 77004
Phone (713) 512-7027

7900 Fannin St
Ste 4000
Houston, TX 77054
Phone (713) 512-7027

10970 Shadow Creek Pkwy
Ste 100
Pearland, TX 77584
Phone (281) 398-8500

17510 W Grand Pkwy S
Ste 430
Sugar Land, TX 77479
Phone (713) 578-3820

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

546 N Kegley Rd
Temple, TX 76502
Phone (254) 215-0900

Interoperability endpoints

  • Direct secure messaging: amye.lilljedahl.1@8042.direct.athenahealth.com

Organizations & group practices 6

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 5

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": "1265068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1174855183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 W PALM ST STE 105",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "774181300",
            "telephone_number": "979-865-3124",
            "fax_number": "979-865-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 W PALM ST STE 106",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "774181300",
            "telephone_number": "979-810-0575",
            "fax_number": "979-810-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLJEDAHL",
        "first_name": "AMYE",
        "middle_name": "SUZETTE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-02",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellville, TX

Sources for this page

Verify at the official NPI Registry.