Individual provider Active NPI

Melodie Alexandra Tedross, PA-C

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1457169898
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20094 Issued in TX
Practice address
6410 Fannin St Ste 350
Houston, TX 77030-3004
Phone
(713) 500-4360
NPI assigned
Dec 18, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA20094 TX Primary

Addresses

Primary practice location

6410 Fannin St Ste 350
Houston, TX 77030-3004

Mailing address

6431 Fannin St
Houston, TX 77030-1501
Phone (713) 500-4360

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
I20260527003438 TX Practitioner - Physician Assistant 0042780488 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)

6410 Fannin St
Houston, TX 77030-3000

6414 Fannin St
Suite G125
Houston, TX 77030-1517

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA20094TXMDPhysician 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": "1734480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1457169898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-500-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 FANNIN ST STE 350",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770303004",
            "telephone_number": "713-500-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDROSS",
        "first_name": "MELODIE",
        "middle_name": "ALEXANDRA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-18",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA20094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.