Individual provider Active NPI

Karl Anthony Simon, P.A.

  • Physician Assistant
  • Dalhart, TX
National Provider Identifier
1356671630
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06580 Issued in TX
Practice address
1411 Denver Ave
Dalhart, TX 79022-4809
Phone
(806) 244-9267
NPI assigned
Jan 8, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1088804 TX
Physician Assistant 363A00000X PA06580 TX Primary

Addresses

Primary practice location

1411 Denver Ave
Dalhart, TX 79022-4809

Mailing address

7415 Broken Oak Lane
Sugar Land, TX 77479
Phone (832) 265-7883

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
I20100824000391 TX Practitioner - Physician Assistant 9335263664 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Track Urgent CareGroup PAC ID 5799005070, 41 clinicians

Practice addresses (Care Compare)

17910 Bulverde Rd
Suite 115
San Antonio, TX 78259-3762
Phone (210) 906-8478

2001 W State Hwy 71
Suite B
La Grange, TX 78945-5058
Phone (210) 906-8478

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1088804TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Track Urgent Care - Bastrop Physician Assistant CurrentSince Aug 17, 2021 Accepting new patients
Oakbend Medical Group CurrentSince Oct 23, 2011 Accepting new patients
Camino Real Emergency Physicians PLLC Physician Assistant Past Accepting new patients

Locations

2001 W State Highway 71
Ste B
La Grange, TX 78945
Phone (979) 206-2288

17910 Bulverde Rd
Ste 115
San Antonio, TX 78259
Phone (210) 906-8478

12007 Alamo Ranch Pkwy
Ste 124
San Antonio, TX 78253
Phone (210) 405-0507

4911 Sandhill Dr
Sugar Land, TX 77479
Phone (281) 238-7870

Organizations & group practices 6

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.

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": "1262908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1356671630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7415 BROKEN OAK LANE",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "77479",
            "telephone_number": "832-265-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 DENVER AVE",
            "city": "DALHART",
            "state": "TX",
            "postal_code": "790224809",
            "telephone_number": "806-244-9267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "KARL",
        "middle_name": "ANTHONY",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-08",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1088804",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalhart, TX

Sources for this page

Verify at the official NPI Registry.