NPIMap

Individual provider Active NPI

Philippe William Petrus, PA-C

  • Physician Assistant
  • El Paso, TX
National Provider Identifier
1639398035
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03331 Issued in TX
Practice address
1900 Denver Ave
El Paso, TX 79902-3008
Phone
(915) 544-4000
NPI assigned
Apr 24, 2007
Last updated
Aug 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

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 PA03331 TX Primary
Medical Physician Assistant 363AM0700X PA03331 TX

Addresses

Primary practice location

1900 Denver Ave
El Paso, TX 79902-3008

Mailing address

1605 George Dieter Dr Ste 636
El Paso, TX 79936-5692
Phone (915) 671-1371

Other practice location 1

6600 Montana Ave Ste P
El Paso, TX 79925-2149
Phone (915) 201-0199

Other identifiers 2

IdentifierTypeStateIssuer
60522321MedicaidNM
203811901MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040612000244 TX Practitioner - Physician Assistant 1355324971 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
La Mente Behavioral Health LLCGroup PAC ID 7911325287, 14 clinicians

Practice addresses (Care Compare)

6600 Montana Ave
Suite P
El Paso, TX 79925-2149
Phone (915) 201-0199

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA03331TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rodom Medical Consulting PA CurrentSince May 1, 2026 Accepting new patients
Louis M Alpern, M.D., M.P.H., P.a. PastSince Aug 21, 2020 Accepting new patients
Physicians and Allied Health Professionals Group, PA Medical Past Accepting new patients
El Paso Hospitalist Group PLLC Physician Assistant Past Accepting new patients
Nueva Vida Adult Daycare, LLC Past Accepting new patients
El Paso Hospitalist Services, PLLC Past Accepting new patients

Locations

901 S Mopac Expy
Bldg 2
Austin, TX 78746
Phone (512) 328-4411

5314 Blanco Ave
El Paso, TX 79905

3101 S Austin Ave
Georgetown, TX 78626
Phone (512) 819-1100

7505 Fannin St
Ste 170
Houston, TX 77054
Phone (713) 702-2670

7601 Fannin St
Houston, TX 77054
Phone (713) 715-4297

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": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1639398035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 GEORGE DIETER DR STE 636",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799365692",
            "telephone_number": "915-671-1371",
            "fax_number": "915-219-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 DENVER AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799023008",
            "telephone_number": "915-544-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 Montana Ave Ste P",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799252149",
            "country_code": "US",
            "telephone_number": "915-201-0199",
            "fax_number": "915-233-3053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUS",
        "first_name": "PHILIPPE",
        "middle_name": "WILLIAM",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03331",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03331",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60522321",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203811901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.