NPIMap

Individual provider Active NPI

Michael Ross, PA

  • Physician Assistant
  • San Angelo, TX
National Provider Identifier
1396853396
Registry record updated Jun 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04079 Issued in TX
Practice address
3502 Knickerbocker Rd
San Angelo, TX 76904-7671
Phone
(325) 942-8611
Fax
(325) 659-0180
NPI assigned
Aug 29, 2006
Last updated
Jun 25, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2013

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 PA04079 TX Primary

Addresses

Primary practice location

3502 Knickerbocker Rd
San Angelo, TX 76904-7671

Mailing address

PO Box 22000
San Angelo, TX 76902-7200
Phone (325) 942-8611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040804000935 TX Practitioner - Physician Assistant 0143290676 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concho County Hospital DistrictGroup PAC ID 3971505298, shared by 5 NPIs, 6 clinicians

Practice addresses (Care Compare)

13 S Main St
Eden, TX 76837-0987

614 Eaker St
Eden, TX 76837-0987
Phone (325) 869-5911

PO Box
Suite 987
Eden, TX 76837-0987

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA04079TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutton County Hospital District CurrentSince Aug 1, 2019 Accepting new patients
Preferred Hospital Leasing Eldorado, Inc. CurrentSince Jan 6, 2020 Accepting new patients
Shannon Clinic CurrentSince Jun 1, 2023 Accepting new patients
Sutton County Hospital District CurrentSince Aug 1, 2019 Accepting new patients
Texas Oncology PA CurrentSince Apr 19, 2004 Accepting new patients
Seton Hospitalist Service Past Accepting new patients
Concho County Hospital District Past Accepting new patients
San Angelo Emergency Medicine Associates PA Physician Assistant Past Accepting new patients
East Texas Medical Center Healthcare Associates Past Accepting new patients
Shannon Clinic Past Accepting new patients

Locations

102 N US Highway 277
Eldorado, TX 76936
Phone (325) 853-2507

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

3501 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 947-6361

3502 Knickerbocker Rd
San Angelo, TX 76904
Phone (325) 747-2222

308 Hudspeth St
Sonora, TX 76950
Phone (325) 387-2521

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 3

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1396853396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-942-8611",
            "fax_number": "325-481-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 KNICKERBOCKER RD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769047671",
            "telephone_number": "325-942-8611",
            "fax_number": "325-659-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Angelo, TX

Sources for this page

Verify at the official NPI Registry.