Individual provider Active NPI

Amy Lynn McDonald, P.A.

  • Physician Assistant
  • Southlake, TX
National Provider Identifier
1518245166
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA07304 Issued in TX
Practice address
300 S Nolen Dr Ste 100
Southlake, TX 76092-8057
Phone
(817) 989-2400
Fax
(817) 549-8463
NPI assigned
Aug 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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 PA07304 TX Primary

Addresses

Primary practice location

300 S Nolen Dr Ste 100
Southlake, TX 76092-8057

Mailing address

3024 Highway 121
Bedford, TX 76021-4037
Phone (817) 494-5000

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
I20120326000674 TX Practitioner - Physician Assistant 4284894486 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The ENT and Allergy Centers of Texas, PLLCGroup PAC ID 4385709054, 56 clinicians

Practice addresses (Care Compare)

300 S Nolen Dr
100 Southlake
Southlake, TX 76092-8057
Phone (817) 989-2400

5220 W University Dr
Suite 150
McKinney, TX 75071-7418
Phone (972) 984-1050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA07304TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Richard D Thrasher III MD PA Past Accepting new patients

Organizations & group practices 3

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": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1518245166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 HIGHWAY 121",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760214037",
            "telephone_number": "817-494-5000",
            "fax_number": "817-494-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S NOLEN DR STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760928057",
            "telephone_number": "817-989-2400",
            "fax_number": "817-549-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-01",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.