Individual provider Active NPI

Grace Jamillia Rushwin

  • Surgical Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1538011366
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA20247 Issued in TX
Practice address
5900 Altamesa Blvd Ste 100
Fort Worth, TX 76132-5475
Phone
(817) 854-9969
Fax
(803) 604-0854
NPI assigned
Feb 12, 2026
Last updated
Apr 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 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 PA20247 TX
Surgical Physician Assistant 363AS0400X PA20247 TX Primary

Addresses

Primary practice location

5900 Altamesa Blvd Ste 100
Fort Worth, TX 76132-5475

Mailing address

4700 Seton Center Pkwy Ste 115
Austin, TX 78759-5753
Phone (817) 854-9969

Other practice location 1

925 Hilltop Dr Ste 101
Weatherford, TX 76086-5890
Phone (817) 854-9969

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
I20260409004126 TX Practitioner - Physician Assistant 6305311093 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4700 Seton Ctr Pkwy
Suite 115
Austin, TX 78759-5753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA20247TXMDSurgical Physician 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1770854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1538011366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 SETON CENTER PKWY STE 115",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787595753",
            "telephone_number": "817-854-9969",
            "fax_number": "803-604-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 ALTAMESA BLVD STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761325475",
            "telephone_number": "817-854-9969",
            "fax_number": "803-604-0854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 Hilltop Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Weatherford",
            "state": "TX",
            "postal_code": "760865890",
            "country_code": "US",
            "telephone_number": "817-854-9969",
            "fax_number": "833-604-0854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSHWIN",
        "first_name": "GRACE",
        "middle_name": "JAMILLIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-12",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA20247",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA20247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.