Individual provider Active NPI

Heather D Rasnake, PA

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1619945862
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA02480 Issued in TX
Practice address
3131 Troup Hwy
Tyler, TX 75701-8350
Phone
(903) 510-7006
Fax
(903) 510-7010
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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 PA02480 TX Primary

Addresses

Primary practice location

3131 Troup Hwy
Tyler, TX 75701-8350

Mailing address

PO Box 5500
Tyler, TX 75712-5500
Phone (903) 324-6400

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
I20100304000168 TX Practitioner - Physician Assistant 0345385118 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

601 Shelley Park PLZ
Tyler, TX 75701-9457
Phone (903) 405-4220

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003840GAMDProfessional Counselor
PA02480TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 1999 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 1999 Accepting new patients
West Alabama Orthopaedic and Sports Medicine, PC Past Accepting new patients

Locations

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

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

3131 Troup Hwy
Tyler, TX 75701
Phone (903) 510-7000

Organizations & group practices 4

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1619945862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5500",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757125500",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 TROUP HWY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757018350",
            "telephone_number": "903-510-7006",
            "fax_number": "903-510-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASNAKE",
        "first_name": "HEATHER",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.