NPIMap

Individual provider Active NPI

Johnson N Mwangi, PA-C

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1578748505
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA011035 Issued in TX
Practice address
1720 S Beckham Ave Ste 102
Tyler, TX 75701-4437
Phone
(903) 618-2125
NPI assigned
Jan 9, 2008
Last updated
Feb 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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 PA011035 TX Primary
Medical Physician Assistant 363AM0700X PA011035 TX

Addresses

Primary practice location

1720 S Beckham Ave Ste 102
Tyler, TX 75701-4437

Mailing address

5310 Harvest Hill Rd Ste 290
Dallas, TX 75230-5826
Phone (214) 420-0650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170510002290 TX Practitioner - Physician Assistant 6608185103 Reassigns benefits to 7 organizations
I20251028000602 OK Practitioner - Physician Assistant 6608185103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epiphany Dermatology PAGroup PAC ID 3971827791, 106 clinicians
Epiphany Dermatology of Oklahoma LLCGroup PAC ID 5597042903, 5 clinicians

Practice addresses (Care Compare)

215 S Denton Tap Rd
Suite 170
Coppell, TX 75019-5066
Phone (469) 312-7302

2805 Prince George Ave
Desoto, TX 75115-2047
Phone (972) 572-1122

3111 Azalea Park Dr
Muskogee, OK 74401-2284
Phone (918) 618-1382

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5622OKMDPhysical Therapist
PA011035TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Jun 12, 2017 Accepting new patients
Epiphany Dermatology of Oklahoma, LLC CurrentSince Oct 1, 2025 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 12, 2017 Accepting new patients
Momentum ER Physicians PLLC Past Accepting new patients
Dermatology Associates PastSince Feb 8, 2023 Accepting new patients
Texas Emergency Room Services PA Past Accepting new patients
Camino Real Emergency Physicians PLLC Physician Assistant Past Accepting new patients

Locations

3111 Azalea Park Dr
Muskogee, OK 74401
Phone (918) 608-1382

7300 Ranch Road 2222
Bldg 1
Austin, TX 78730

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

1720 S Beckham Ave
Ste 102
Tyler, TX 75701
Phone (903) 534-6200

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jmwangi576553@ahs.direct-ci.com

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1578748505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 HARVEST HILL RD STE 290",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752305826",
            "telephone_number": "214-420-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 S BECKHAM AVE STE 102",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757014437",
            "telephone_number": "903-618-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWANGI",
        "first_name": "JOHNSON",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-09",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA011035",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA011035",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.