Elite PA Surgical Assists, PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

TX11021 Issued in TX

Legal business name

ELITE PA SURGICAL ASSISTS, PLLC

Practice address

2600 E Southlake Blvd Ste 120-177
Southlake, TX 76092-6634

Phone

(469) 708-3989

NPI assigned

Aug 29, 2017

Organization subpart

No

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

Authorized official

Name

Paulina Purnama, PA-CNPI 1275724981

Title

Owner

Phone

(469) 708-3989

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paulina Purnama, PA-C

  • Surgical Physician Assistant
  • Fort Worth, TX
  • NPI 1275724981
  NPD Authorized official

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1346767431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHLAKE BLVD STE 120-177",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926634",
            "telephone_number": "469-708-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHLAKE BLVD STE 120-177",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926634",
            "telephone_number": "469-708-3989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PA SURGICAL ASSISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-29",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "PURNAMA",
        "authorized_official_first_name": "PAULINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-708-3989",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": "TX11021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Orthopaedic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.