Tresarae Shawn Thomas, P.A.C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-430 Issued in AL

Practice address

2505 US Highway 431
Boaz, AL 35957

Phone

(256) 593-8310

NPI assigned

Nov 30, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tresarae Pate Lane Former name

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Alabama Emergency Physician Partners, LLC

  • Emergency Medicine Physician
  • Gadsden, AL
  • NPI 1891031894

  AL

  Medicare reassignment
• App of Alabama Ed PLLC

  • Emergency Medicine Physician
  • Russellville, AL
  • NPI 1659646040

  AL

  Medicare reassignment
• Marshall Medical Center South

  • Obstetrics & Gynecology Physician
  • Boaz, AL
  • NPI 1639321789

  AL

  Medicare reassignment
• Alabama Emergency Physician Partners, LLC

  • Emergency Medicine Physician
  • Gadsden, AL
  • NPI 1194106443
  NPD
• Central Alabama Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Boaz, AL
  • NPI 1992952964
  NPD (past)

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1508840828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 TURNPIKE RD",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359500501",
            "telephone_number": "256-572-3271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 US HIGHWAY 431",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "35957",
            "telephone_number": "256-593-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "TRESARAE",
        "middle_name": "SHAWN",
        "name_prefix": "Ms.",
        "credential": "P.A.C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA-430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009933282",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA STATE LICENSE",
            "identifier": "PA-430",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRESARAE",
            "last_name": "PATE LANE",
            "credential": "P.A.C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Hailey A Taylor, CRNP
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• Mark Layne Turk, O.D.
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• Jacqueline Valadez, DO

• All providers in Boaz, AL
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.