Individual provider Active NPI

Travis Householder, PA-C

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1285032367
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3037 Issued in NV
Practice address
3150 N Tenaya Way Ste 260
Las Vegas, NV 89128-0459
Phone
(702) 962-5920
NPI assigned
Dec 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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 PA3037 NV Primary

Addresses

Primary practice location

3150 N Tenaya Way Ste 260
Las Vegas, NV 89128-0459

Mailing address

PO Box 100744
Atlanta, GA 30384-6666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151229000076 NM Practitioner - Physician Assistant 3678890548 Reassigns benefits to 1 organization
I20240820002841 NV Practitioner - Physician Assistant 3678890548 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sunrise Mountainview Multispecialty Clinics LLCGroup PAC ID 1759469711, 64 clinicians

Practice addresses (Care Compare)

3100 N Tenaya Way
Las Vegas, NV 89128-0436
Phone (702) 255-5000

3186 S Maryland Pkwy
Las Vegas, NV 89109-2317
Phone (702) 731-8115

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA3037NVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Dec 21, 2015 Accepting new patients
Presbyterian Healthcare Services CurrentSince Dec 21, 2015 Accepting new patients

Locations

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

Interoperability endpoints

  • Direct secure messaging: travis.householder@hca3.eclinicaldirectplus.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.

Hospital & facility affiliations 1

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": "1417737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1285032367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100744",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303846666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY STE 260",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280459",
            "telephone_number": "702-962-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSEHOLDER",
        "first_name": "TRAVIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-05",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA3037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.