Idris Shoaga, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA09503 Issued in TX

Practice address

1875 County Road 101
Suite 170
Manvel, TX 77578

Phone

(281) 692-9770

Fax

(281) 692-9771

NPI assigned

Dec 9, 2014

Last updated

Apr 10, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: idris.shoaga.1@19897.direct.athenahealth.com

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.

• Apt Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Manvel, TX
  • NPI 1013557297
  Medicare reassignment Authorized official
• Ut Physicians

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1033157821
  Medicare reassignment NPD
• Acs Primary Care Physicians Southwest, PA

  • Emergency Medicine Physician
  • Gainesville, TX
  • NPI 1538101019
  Medicare reassignment
• Ut Physicians

  dba UT Health Services

  • Health Educator
  • Houston, TX
  • NPI 1316534472
  NPD
• Memorial Hermann Health System

  dba Memorial Hermann Pharmacy-TMC

  • Community/Retail Pharmacy
  • Houston, TX
  • NPI 1366229619
  NPD (past)

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1255739157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 COUNTY ROAD 101",
            "address_2": "SUITE 170",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "77578",
            "telephone_number": "281-692-9770",
            "fax_number": "281-692-9771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 COUNTY ROAD 101",
            "address_2": "SUITE 170",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "77578",
            "telephone_number": "281-692-9770",
            "fax_number": "281-692-9771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOAGA",
        "first_name": "IDRIS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-09",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA09503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendell Lawrence Seymour, APRN
• Andargachew B Seyoum
• Shatleh Optometry, PLLC (Essential Vision Center)
• Lindsay Shelton, M.ED, LPC
• Shiloh Treatment Center, Inc.
• Melissa Ann Sifuentes
• Gabrielle Darian Silguero
• Debora Joyce Simmons, RN CCNS FAAN
• Haley Sincere
• Kenisha Slade

• Medical Physician Assistant in Manvel, TX
• Providers in Manvel, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.