Individual provider Active NPI

Renee Marie Wilson, PA

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1407229024
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10138 Issued in TX
Practice address
1515 Holcombe Blvd
Houston, TX 77030-4009
Phone
(713) 792-6161
NPI assigned
Nov 4, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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 PA10138 TX Primary

Addresses

Primary practice location

1515 Holcombe Blvd
Houston, TX 77030-4009

Mailing address

PO Box 4439
Houston, TX 77210-4439
Phone (713) 792-2991

Other identifiers 1

IdentifierTypeStateIssuer
361399401MedicaidTX

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
I20151208001257 TX Practitioner - Physician Assistant 2062712425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Referral ServiceGroup PAC ID 7911801410, 2,728 clinicians

Practice addresses (Care Compare)

100 Fellowship Dr
Conroe, TX 77384-4797
Phone (713) 563-0050

2130 W Holcombe Blvd
Univ of TX M D Ande Life Sciences Plaza
Houston, TX 77030-4009
Phone (713) 592-5433

9922 Louetta Rd
Houston, TX 77070-1468
Phone (713) 794-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.29 of 100Reported as group
Quality
70.82
Promoting interoperability
100
Improvement activities
40
Cost
67.65

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: rwilson40057@utmdandersoncc.direct-ci.com

Organizations & group practices 1

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.

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": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475539200000",
    "number": "1407229024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4439",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104439",
            "telephone_number": "713-792-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304009",
            "telephone_number": "713-792-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RENEE",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2016-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "361399401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.