Michael McKelva

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA11152 Issued in TX

Practice address

630 S Fleishel Ave
Tyler, TX 75701-2041

Phone

(903) 606-5560

NPI assigned

Mar 27, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmckelva243061@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment Care Compare group NPD
• Texas Spine and Joint Hospital, LLC

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1942292255
  Medicare reassignment
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Care Compare affiliation

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1346771748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 N MACARTHUR BLVD",
            "address_2": "SUITE 100",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750612221",
            "telephone_number": "972-438-4636",
            "fax_number": "972-438-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012041",
            "telephone_number": "903-606-5560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2120 N MacArthur Blvd",
            "address_2": "SUITE 100",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750612221",
            "country_code": "US",
            "telephone_number": "972-438-4636 x1101",
            "fax_number": "972-438-6585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKELVA",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA11152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370509704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chance Michael McInnis
• Mary Angela McInnis, DNP, APRN, ENP, FNP
• David Douglas McIntire, R.PH.
• David Clay McIntyre, AGNP-C
• Jennifer Marie McKelva, PA-C
• Jennifer May McKenzie, RN
• Robert Wayne McKenzie, PH.D.
• Deborah McKinley- Waggoner
• James Wayne McKinley, M.D.
• Ivan McKinney, DDS

• Surgical Physician Assistant in Tyler, TX
• Providers in Tyler, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.

Verify at the official NPI Registry.