Active NPI
Michael Chad Elliott, PA-C
- Medical Physician Assistant
- Wake Village, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA12400
- Practice address
- 5212 W 7TH St
Wake Village, TX 75501-5930 - Phone
- (903) 831-6848
- Fax
- (903) 223-7089
- NPI assigned
- Oct 23, 2018
- Last updated
- Feb 26, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA12400 | TX | Primary |
Addresses
Primary practice location
5212 W 7TH St
Wake Village, TX 75501-5930
Mailing address
5212 W 7TH St
Wake Village, TX 75501-5930
Phone (903) 831-6848
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200859940A | Medicaid | OK | |
| P02599432 | Other | TX | RR MCR |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5212 W 7TH St
Wake Village, TX 75501-5930
Phone (903) 831-6848
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA12400 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| C H Wilkinson Physician Network | Current | Accepting new patients | |
| C H Wilkinson Physician Network | Current | Accepting new patients | |
| Christus Trinity Clinic Texas | Current | Accepting new patients |
Locations
1276 S Peachtree St
Jasper, TX 75951
Phone (409) 384-5701
1002 Texas Blvd
Ste 406
Texarkana, TX 75501
Phone (903) 794-4196
2602 Saint Michael Dr
Ste 302B
Texarkana, TX 75503
Phone (903) 614-5180
2900 Saint Michael Dr
Ste 401
Texarkana, TX 75503
Phone (903) 614-5353
630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888
5212 W 7th St
Wake Village, TX 75501
Phone (903) 791-9120
Interoperability endpoints
- https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
- michaelelliott@fmgt.allscriptsdirect.net
Organizations & group practices 5
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.
-
- Family Medicine Physician
- Texarkana, TX
- NPI 1831233766
-
dba CHRISTUS Physician Group
- Family Medicine Physician
- Irving, TX
- NPI 1457382947
-
dba Christus Trinity Clinic
- Family Medicine Physician
- Tyler, TX
- NPI 1285684225
-
dba CHRISTUS Physician Group
- Orthopaedic Surgery Physician
- Corpus Christi, TX
- NPI 1750826095
-
dba Christus Trinity Clinic
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1801673165
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Christus St. Michael Health System
- General Practice Physician
- Texarkana, TX
- NPI 1184623266
Hospital
-
dba CHRISTUS St. Michael Health System
- General Acute Care Hospital
- Texarkana, TX
- NPI 1295736734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740528000000",
"number": "1306312822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5212 W 7TH ST",
"city": "WAKE VILLAGE",
"state": "TX",
"postal_code": "755015930",
"telephone_number": "903-831-6848",
"fax_number": "903-223-7089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5212 W 7TH ST",
"city": "WAKE VILLAGE",
"state": "TX",
"postal_code": "755015930",
"telephone_number": "903-831-6848",
"fax_number": "903-223-7089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "MICHAEL",
"middle_name": "CHAD",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-23",
"last_updated": "2025-02-26",
"certification_date": "2025-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA12400",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200859940A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCR",
"identifier": "P02599432",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wake Village, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.