Individual provider Active NPI

Kila D Nsamenang, PA-C

  • Medical Physician Assistant
  • Pleasanton, TX
National Provider Identifier
1215169966
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA5897 Issued in MA
Practice address
310 W Oaklawn Rd
Pleasanton, TX 78064-4033
Phone
(830) 569-8940
Fax
(830) 569-8527
NPI assigned
Aug 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA5897 MA Primary

Addresses

Primary practice location

310 W Oaklawn Rd
Pleasanton, TX 78064-4033

Mailing address

195 Canal St
Malden, MA 02148-6701
Phone (830) 569-8940

Other identifiers 1

IdentifierTypeStateIssuer
211975201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20191024000466 IL Practitioner - Physician Assistant 4183754807 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Sep 12, 2020 Accepting new patients
Access Community Health Network CurrentSince Sep 12, 2020 Accepting new patients

Locations

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

Organizations & group practices 3

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": "1250121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489622400000",
    "number": "1215169966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 CANAL ST",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021486701",
            "telephone_number": "830-569-8940",
            "fax_number": "830-569-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W OAKLAWN RD",
            "city": "PLEASANTON",
            "state": "TX",
            "postal_code": "780644033",
            "telephone_number": "830-569-8940",
            "fax_number": "830-569-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NSAMENANG",
        "first_name": "KILA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-13",
        "last_updated": "2017-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA5897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211975201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, TX

Sources for this page

Verify at the official NPI Registry.