Individual provider Active NPI

Amy Renee McDonald, PA-C

  • Physician Assistant
  • Lubbock, TX
National Provider Identifier
1366629313
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03966 Issued in TX
Practice address
602 Indiana Ave
Lubbock, TX 79415
Phone
(806) 775-8600
Fax
(806) 775-8602
NPI assigned
Jan 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA03966 TX Primary

Addresses

Primary practice location

602 Indiana Ave
Lubbock, TX 79415

Mailing address

PO Box 5865
Lubbock, TX 79408-5865
Phone (806) 743-2898

Other practice location 1

5323 Harry Hines Boulevard
Dallas, TX 75390-7208
Phone (214) 456-2382

Other practice location 2

5323 Harry Hines Boulevard
Dallas, TX 75390-7208
Phone (214) 456-2382

Other names 1

  • Amy Renee Waide Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amy.mcdonald@direct.myteamcare.com

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
I20080530000646 TX Practitioner - Physician Assistant 6608946843 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center El Paso CurrentSince Nov 11, 2017 Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Nov 11, 2017 Accepting new patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Nov 11, 2017 Accepting new patients
Physicians and Allied Health Professionals Group, PA Past Accepting new patients

Locations

3502 9th St
Ste 130
Lubbock, TX 79415
Phone (806) 743-1188

602 Indiana Ave
Lubbock, TX 79415
Phone (806) 743-2898

4000 24th St
#410
Lubbock, TX 79410
Phone (806) 743-7700

Interoperability endpoints

  • Direct secure messaging: amy.mcdonald@direct.myteamcare.com

Organizations & group practices 7

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": "1200960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1366629313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5865",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794085865",
            "telephone_number": "806-743-2898",
            "fax_number": "806-743-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 INDIANA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79415",
            "telephone_number": "806-775-8600",
            "fax_number": "806-775-8602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5323 Harry Hines Boulevard",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907208",
            "country_code": "US",
            "telephone_number": "214-456-2382",
            "fax_number": "214-456-6133",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5323 Harry Hines Boulevard",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753907208",
            "country_code": "US",
            "telephone_number": "214-456-2382",
            "fax_number": "214-456-6133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "AMY",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-22",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amy.mcdonald@direct.myteamcare.com",
            "affiliation": "N",
            "address_1": "602 Indiana Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "79415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "WAIDE",
            "middle_name": "RENEE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.