Active NPI
Anne Elizabeth Pratt, PA-C
- Physician Assistant
- Longview, TX
National Provider Identifier
1629094396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA07060
- Practice address
- 2901 N 4TH St
ER Department
Longview, TX 75605-5128 - Phone
- (903) 757-6042
- NPI assigned
- Jul 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA10609RX | LA | |
| Physician Assistant | 363A00000X | PA07060 | TX | Primary |
Addresses
Primary practice location
2901 N 4TH St
ER Department
Longview, TX 75605-5128
Mailing address
PO Box 847176
Dallas, TX 75284-7176
Phone (903) 237-1800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1624951 | Medicaid | LA | |
| 286609702 | Medicaid | TX | |
| 5F600P518 | Other | LA | MEDICARE - PTAN |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10609RX | LA | MD | Medical 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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Gainesville, TX
- NPI 1538101019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1629094396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847176",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847176",
"telephone_number": "903-237-1800",
"fax_number": "903-237-1810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 N 4TH ST",
"address_2": "ER DEPARTMENT",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756055128",
"telephone_number": "903-757-6042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATT",
"first_name": "ANNE",
"middle_name": "ELIZABETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "LA",
"license": "PA10609RX",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA07060",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1624951",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "286609702",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - PTAN",
"identifier": "5F600P518",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.