Individual provider Active NPI

Alexis Mellem

  • Neonatal Nurse Practitioner
  • Round Rock, TX
National Provider Identifier
1346522877
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
AP121297 Issued in TX
Practice address
300 University Blvd
Round Rock, TX 78665-1032
Phone
(512) 509-0100
NPI assigned
Sep 11, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 719875 TX
Neonatal Nurse Practitioner 363LN0000X AP121297 TX Primary

Addresses

Primary practice location

300 University Blvd
Round Rock, TX 78665-1032

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (512) 963-2807

Other practice location 1

1201 W 38th St Fl 8
Austin, TX 78705-1006
Phone (512) 324-1085

Other practice location 2

3220 Feathergrass Ct
apt 9125
Austin, TX 78758-7777
Phone (512) 963-2807

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amellem1258235@direct.sw.org 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
I20231116001217 TX Practitioner - Nurse Practitioner 1254788045 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
719875TXMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Scott and White Clinic CurrentSince Nov 13, 2023 Accepting new patients
Scott & White Clinic Current Accepting new patients
Scott & White Clinic CurrentSince Nov 13, 2023 Accepting new patients

Locations

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

300 University Blvd
Round Rock, TX 78665
Phone (512) 509-0100

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

Interoperability endpoints

  • Direct secure messaging: amellem1258235@direct.sw.org

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": "1315699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1346522877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "512-963-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 W 38th St Fl 8",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787051006",
            "country_code": "US",
            "telephone_number": "512-324-1085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3220 Feathergrass Ct",
            "address_2": "apt 9125",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787587777",
            "country_code": "US",
            "telephone_number": "512-963-2807",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELLEM",
        "first_name": "ALEXIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-11",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TX",
            "license": "719875",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TX",
            "license": "AP121297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amellem1258235@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 University Blvd",
            "city": "Round Rock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786651032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.