Anne Mickleburgh, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02063 Issued in TX

Practice address

2304 Marketplace Dr
Waco, TX 76711-2467

Phone

(254) 202-7300

Fax

(254) 202-7350

NPI assigned

Apr 12, 2007

Last updated

Sep 23, 2020By 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

Electronic endpoints 1

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

University of Texas Medical Branch at Galveston, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Legacy Urgent Care PAGroup PAC ID 3072679828, 157 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: amickleburgh576121@direct.sw.org
• Direct secure messaging: anne.mickleburgh.1@9635.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/856/brand/1/csg/1/fhir/r4

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.

• Legacy Urgent Care, PA

  • Urgent Care Clinic/Center
  • Frisco, TX
  • NPI 1568622272
  Medicare reassignment Care Compare group
• Cardiothoracic and Vascular Surgeons,PA

  dba VeinSolutions

  • Surgery Physician
  • Austin, TX
  • NPI 1326061714
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1629292669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848476",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752848476",
            "telephone_number": "254-202-4655",
            "fax_number": "254-202-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 MARKETPLACE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767112467",
            "telephone_number": "254-202-7300",
            "fax_number": "254-202-7350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4303 Victory Dr",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787048870",
            "country_code": "US",
            "telephone_number": "512-462-3627",
            "fax_number": "512-462-3431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKLEBURGH",
        "first_name": "ANNE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amickleburgh576121@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2304 Marketplace Dr",
            "city": "Waco",
            "state": "TX",
            "country_code": "US",
            "postal_code": "767112467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael P Teichelmann MD PA
• Jill Francis Michaels, DDS
• Abbey Leeann Michel, MD
• Kimberly Michna
• Benetta L Mickens
• Patricia Jane Micklos, PSY.D.
• Kimberly L. Micus, M.D.
• Mid Tex Anesthesia Associates, PA
• Maggie Middlebrooks, APRN-CNP
• Midori Management Partners LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.