Merciful Ekongmadem Eyongegbe, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA16986 Issued in TX

Practice address

851 W Terrell Ave
Fort Worth, TX 76104-3161

Phone

(817) 756-7385

Fax

(817) 332-1723

NPI assigned

Jul 7, 2023

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Vascular and Vein Center PA

  • Vascular Surgery Physician
  • Fort Worth, TX
  • NPI 1013173764
  Medicare reassignment

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689379200000",
    "number": "1629756986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33434",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761623434",
            "telephone_number": "817-332-8346",
            "fax_number": "817-332-1723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 W TERRELL AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043161",
            "telephone_number": "817-756-7385",
            "fax_number": "817-332-1723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EYONGEGBE",
        "first_name": "MERCIFUL",
        "middle_name": "EKONGMADEM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-15",
        "certification_date": "2023-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA16986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyemasters of Texas LTD (EyeMasters)
• Eyemasters of Texas LTD (EyeMasters)
• Eyes First Inc (Pearle Vision)
• Eyes on Camp Bowie, PA
• Eyeworks at West 7TH
• Johnson Ezebuiro
• Anitha Ezekiel-Houghton, MD
• Hannah Ezekiel
• Justin H Ezell, D.O.
• Dawn Denise Ezelle, COTA

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2023; 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.

Verify at the official NPI Registry.