Michelle Wijaya, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA18501 Issued in TX

Practice address

13938 Highway 3 # 100
Webster, TX 77598-1622

Phone

(281) 332-9681

NPI assigned

Nov 12, 2024

Last updated

Nov 12, 2024By the provider in NPPES

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

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

Specialty

Physician Assistant

Education

Other

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clear Lake Dermatology PLLCGroup PAC ID 6800044181, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Clear Lake Dermatology, PLLC

  dba Clear Lake Dermatology

  • Dermatology Physician
  • Webster, TX
  • NPI 1255686465
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1558185066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13938 HIGHWAY 3 # 100",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775981622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13938 HIGHWAY 3 # 100",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775981622",
            "telephone_number": "281-332-9681"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2508 Gulf Fwy S Ste 110",
            "address_purpose": "LOCATION",
            "city": "League City",
            "state": "TX",
            "postal_code": "775736743",
            "country_code": "US",
            "telephone_number": "281-310-5881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIJAYA",
        "first_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA18501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannette Rebbecca White, APRN-CNP
• Tameka C White, MS, CCC-SLP
• Shirley Campbell Whitefield, CRNA
• Daniel E Whitman, MD
• Mary Diane Whitten, R.N.
• Madison Nicole Wiley
• Amanda Crabtree Wilke, MSN, ACNP-BC
• Akil Williams, NP-C
• Alissa Renee Williams
• Gwendolyn A Williams, MD

• Physician Assistant in Webster, TX
• Providers in Webster, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.