Patrick Gyamfi Addo, PA

Key facts

NPI

1275706830

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

PA06202 (TX)

Practice address

1350 N Westmoreland Rd
Dallas, TX 75211-1654

Phone

(214) 689-5140

Fax

(214) 630-3625

NPI assigned

Apr 3, 2008

Sex

Male

Sole proprietor

Yes

Organizations & group practices 2

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.

• Department of State Health Services Clinic/Center · San Antonio, TX · NPI 1316000144
  NPD (past)
• Health and Human Services Commission Psychiatric Hospital · Big Spring, TX · NPI 1881600682
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 19, 2012.

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1275706830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 RIVER BEND DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752474914",
            "telephone_number": "214-743-6159",
            "fax_number": "214-689-6482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N WESTMORELAND RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752111654",
            "telephone_number": "214-689-5140",
            "fax_number": "214-630-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDO",
        "first_name": "PATRICK",
        "middle_name": "GYAMFI",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-03",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06202",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19649",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA053771",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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