Individual provider Active NPI

Tammy R Wall, PA-C

  • Physician Assistant
  • Corpus Christi, TX
National Provider Identifier
1245348358
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03796 Issued in TX
Practice address
4254 S Alameda St
Corpus Christi, TX 78412-2469
Phone
(361) 853-4191
Fax
(361) 853-8768
NPI assigned
Aug 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 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 PA03796 TX Primary

Addresses

Primary practice location

4254 S Alameda St
Corpus Christi, TX 78412-2469

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Phone (361) 853-4191

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tammy.wall.1@29601.direct.athenahealth.com Direct

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
I20040803001003 TX Practitioner - Physician Assistant 3072584101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conviva Medical Center Management of Texas, P.a.Group PAC ID 8729302278, 146 clinicians

Practice addresses (Care Compare)

260 US Hwy 181 N
Floresville, TX 78114-3136
Phone (830) 393-8222

4254 S Alameda St
Corpus Christi, TX 78412-2469
Phone (361) 853-4191

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA03796TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centerwell Senior Primary Care (SC) PC CurrentSince Aug 4, 2025 Accepting new patients
Corpus Christi Family Medicine Center PA Past Accepting new patients

Locations

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

4254 S Alameda St
Corpus Christi, TX 78412
Phone (361) 500-4351

260 US Highway 181 N
Floresville, TX 78114
Phone (830) 393-8222

Interoperability endpoints

  • Direct secure messaging: tammy.wall@415054778073092.direct.elationemr.com
  • Direct secure messaging: tammy.wall.1@29601.direct.athenahealth.com

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1245348358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "361-853-4191",
            "fax_number": "361-853-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4254 S ALAMEDA ST",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784122469",
            "telephone_number": "361-853-4191",
            "fax_number": "361-853-8768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "TAMMY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tammy.wall.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4254 S Alameda St",
            "city": "Corpus Christi",
            "state": "TX",
            "country_code": "US",
            "postal_code": "784122469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Corpus Christi, TX

Sources for this page

Verify at the official NPI Registry.