Individual provider Active NPI

Marissa A Medrano

  • Physician Assistant
  • Edinburg, TX
National Provider Identifier
1407547540
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20252 Issued in TX
Practice address
1201 West University Drive
Edinburg, TX 78539-2999
Phone
(956) 665-7049
NPI assigned
May 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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 PA20252 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1201 West University Drive
Edinburg, TX 78539-2999

Mailing address

1201 West University Drive
Edinburg, TX 78539-2999
Phone (956) 665-7049

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
I20260511002017 TX Practitioner - Physician Assistant 7911475611 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

17119 Tangelo Ave
Harlingen, TX 78552-2754

4535 Dressier Rd NW
Canton, OH 44718-2545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA20252TXMDPhysician Assistant

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1407547540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 WEST UNIVERSITY DRIVE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785392999",
            "telephone_number": "956-665-7049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 WEST UNIVERSITY DRIVE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785392999",
            "telephone_number": "956-665-7049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDRANO",
        "first_name": "MARISSA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-18",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA20252",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edinburg, TX

Sources for this page

Verify at the official NPI Registry.