Individual provider Active NPI

Christie Diane Ambriz, PA-C

  • Physician Assistant
  • Raymondville, TX
National Provider Identifier
1770791279
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
04887 Issued in TX
Practice address
165 S 6TH St
Raymondville, TX 78580-3521
Phone
(956) 689-5506
Fax
(956) 689-1988
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 04887 TX Primary

Addresses

Primary practice location

165 S 6TH St
Raymondville, TX 78580-3521

Mailing address

165 S 6TH St
Raymondville, TX 78580-3521
Phone (956) 689-5506

Other identifiers 1

IdentifierTypeStateIssuer
PA04887OtherTXTX LICENSE

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141028000134 TX Practitioner - Physician Assistant 7911138094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Donna Medical Clinic, PLLCGroup PAC ID 1153216734, 35 clinicians

Practice addresses (Care Compare)

307 N D Salinas Ave
Donna, TX 78537-2929

307 N D Salinas Blvd
Donna, TX 78537-2929
Phone (956) 464-2402

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04887TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aha Family Clinic, PLLC Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1770791279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 S 6TH ST",
            "city": "RAYMONDVILLE",
            "state": "TX",
            "postal_code": "785803521",
            "telephone_number": "956-689-5506",
            "fax_number": "956-689-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 S 6TH ST",
            "city": "RAYMONDVILLE",
            "state": "TX",
            "postal_code": "785803521",
            "telephone_number": "956-689-5506",
            "fax_number": "956-689-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBRIZ",
        "first_name": "CHRISTIE",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "04887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX LICENSE",
            "identifier": "PA04887",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raymondville, TX

Sources for this page

Verify at the official NPI Registry.