NPIMap

Individual provider Active NPI

Samuel Allan Waddell, PA-C

  • Physician Assistant
  • Pittsburg, TX
National Provider Identifier
1194033803
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06784 Issued in TX
Practice address
2701 US Highway 271 N
Pittsburg, TX 75686-4289
Phone
(903) 946-5442
Fax
(903) 946-5258
NPI assigned
Sep 15, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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 PA06784 TX Primary

Addresses

Primary practice location

2701 US Highway 271 N
Pittsburg, TX 75686-4289

Mailing address

2701 US Highway 271 N
Pittsburg, TX 75686-4289
Phone (903) 946-5442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110228000574 TX Practitioner - Physician Assistant 6507047313

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pittsburg Hospital LLCGroup PAC ID 5597029272, 16 clinicians

Practice addresses (Care Compare)

2701 US Hwy 271 N
Pittsburg, TX 75686-4289
Phone (903) 946-5442

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Mount Pleasant, TX, CCN 457210
  • Vitalcaring Group Home health agency, Henderson, TX, CCN 458072
  • Ut Health East Texas Home Health Services Home health agency, Pittsburg, TX, CCN 677037
  • Elara Caring Home health agency, Mount Vernon, TX, CCN 457507
  • Chambers Home Health Agency of Northeast Texas Com Home health agency, Mount Pleasant, TX, CCN 679171
  • Ut Health East Texas Pittsburg Hospital Hospital, Pittsburg, TX, CCN 451367
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • University of Texas Health Science Center at Tyler Hospital, Tyler, TX, CCN 450690

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Upshur Emergency Medicine Associates PA Past Accepting new patients
Pittsburg Hospital LLC Past Accepting new patients
Starks Medical Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: swaddell355113@ahs.direct-ci.com

Organizations & group practices 5

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 8

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": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1194033803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 US HIGHWAY 271 N",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756864289",
            "telephone_number": "903-946-5442",
            "fax_number": "903-946-5258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 US HIGHWAY 271 N",
            "city": "PITTSBURG",
            "state": "TX",
            "postal_code": "756864289",
            "telephone_number": "903-946-5442",
            "fax_number": "903-946-5258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "SAMUEL",
        "middle_name": "ALLAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburg, TX

Sources for this page

Verify at the official NPI Registry.