Active NPI
Edward Angel Colon, PA-C
- Physician Assistant
- Rosenberg, TX
National Provider Identifier
1376500256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00671
- Practice address
- 7607 Town Center Blvd
Rosenberg, TX 77471-6219 - Phone
- (281) 344-0207
- Fax
- (281) 239-0114
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00671 | TX | Primary |
Addresses
Primary practice location
7607 Town Center Blvd
Rosenberg, TX 77471-6219
Mailing address
2100 Regional Medical Dr
Wharton, TX 77488-9719
Phone (979) 532-1700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01090443 | Other | TX | RAILROAD MEDICARE PTAN |
| 307544201 | Medicaid | TX | |
| 875N29 | Other | TX | BC/BS # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00671 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pucillo Family Practice PA | Current | Accepting new patients | |
| South Texas Medical Clinics, P.a. | Past | Accepting new patients |
Locations
16659 Southwest Fwy
Ste 461
Sugar Land, TX 77479
Phone (281) 340-9355
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Sugar Land, TX
- NPI 1356427090
-
- General Practice Physician
- East Bernard, TX
- NPI 1114077427
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368144000000",
"number": "1376500256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 REGIONAL MEDICAL DR",
"city": "WHARTON",
"state": "TX",
"postal_code": "774889719",
"telephone_number": "979-532-1700",
"fax_number": "979-532-4584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7607 TOWN CENTER BLVD",
"city": "ROSENBERG",
"state": "TX",
"postal_code": "774716219",
"telephone_number": "281-344-0207",
"fax_number": "281-239-0114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLON",
"first_name": "EDWARD",
"middle_name": "ANGEL",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2013-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA00671",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PTAN",
"identifier": "P01090443",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "307544201",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS #",
"identifier": "875N29",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rosenberg, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.