Active NPI
Ken D Novak, PA
- Physician Assistant
- Little Elm, TX
National Provider Identifier
1780608760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA02025
- Practice address
- 800 W. Eldorado Pkwy
Little Elm, TX 75068 - Phone
- (972) 292-0300
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA02025 | TX | Primary |
Addresses
Primary practice location
800 W. Eldorado Pkwy
Little Elm, TX 75068
Mailing address
800 W. Eldorado Pkwy
Little Elm, TX 75068
Phone (972) 292-0300
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182410403 | Medicaid | TX | |
| 182410401 | Medicaid | TX | |
| 182410404 | Medicaid | TX | |
| 182410405 | Medicaid | TX | |
| 182410402 | Medicaid | TX | |
| 182410406 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians and Allied Health Professionals Group, PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Dallas, TX
- NPI 1528011814
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388016000000",
"number": "1780608760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 W. ELDORADO PKWY",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "75068",
"telephone_number": "972-292-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 W. ELDORADO PKWY",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "75068",
"telephone_number": "972-292-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVAK",
"first_name": "KEN",
"middle_name": "D",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2013-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA02025",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410403",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410401",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410404",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410405",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410402",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182410406",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Elm, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.