Mary L Moore, PA C
Individual provider Active NPI Medical Physician Assistant · Pearsall, TX
NPI 1770514614 · NPPES record last updated Mar 24, 2011
Key facts
- NPI
- 1770514614
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA02513 (TX)
- Practice address
- 105 E Hackberry St
Pearsall, TX 78061-4412 - Phone
- (830) 334-3670
- Fax
- (830) 334-3672
- NPI assigned
- Jul 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Frio Hospital Association
Practice addresses (Care Compare)
151 Medical Dr
Pearsall, TX 78061-6604
Hospital & facility affiliations
- Frio Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150824000062 | TX | Practitioner - Physician Assistant | 4385959139 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sound Inpatient Physicians of Texas I, Inc | Current |
Accepting new patients | |
| Frio Hospital Association | Current |
Accepting new patients | |
| Frio Hospital Association | Current |
Accepting new patients | |
| Alfonso H Luevano MD P a | Medical | Past | Accepting new patients |
| Frio Hospital Association | Past | Accepting new patients |
Locations
801 W FM 117
Dilley, TX 78017
Phone (830) 326-3171
7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000
151 Medical Dr
Pearsall, TX 78061
Phone (830) 334-4126
200 S Interstate 35
Pearsall, TX 78061
Phone (888) 250-2326
105 E Hackberry St
Ste B
Pearsall, TX 78061
Phone (830) 334-2002
17500 W Grand Pkwy S
Sugar Land, TX 77479
Phone (281) 725-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA02513 | TX | Yes |
Addresses
Primary practice location
105 E Hackberry St
Pearsall, TX 78061-4412
Mailing address
151 Encino Drive
Pearsall, TX 78061
Phone (830) 334-3670
Other providers in Pearsall, TX
- Kathy Martinez
- Silvia Oralia Martinez
- Sneha Mathew
- Medical Supplies Depot LLC
- Roxanna Medina
- Munoz Pediatric Healthcare Services, PLLC
- Manuel Munoz III
- Nix Community General Hospital, LLC
- Gustavo Adolfo Ortegon
- Oscar Garza M.D.
All providers in Pearsall, TX · Medical Physician Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.