Individual provider Active NPI

Kenzie Danae Perryman, PA-C

  • Physician Assistant
  • San Antonio, TX
National Provider Identifier
1881260446
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA14681 Issued in TX
Practice address
4611 Centerview
San Antonio, TX 78228-1202
Phone
(210) 255-8935
Fax
(210) 255-8026
NPI assigned
Jun 3, 2021
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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 PA14681 TX Primary

Addresses

Primary practice location

4611 Centerview
San Antonio, TX 78228-1202

Mailing address

4611 Centerview
San Antonio, TX 78228-1202
Phone (210) 255-8935

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
I20210622001120 TX Practitioner - Physician Assistant 0749681252 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NSC Consultants, PAGroup PAC ID 5991850414, 9 clinicians

Practice addresses (Care Compare)

4611 Centerview
San Antonio, TX 78228-1202
Phone (210) 255-8935

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA14681TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
M. Reza Mizani, M.D., P.a. PastSince Jul 3, 2022 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1881260446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 CENTERVIEW",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281202",
            "telephone_number": "210-255-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 CENTERVIEW",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281202",
            "telephone_number": "210-255-8935",
            "fax_number": "210-255-8026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRYMAN",
        "first_name": "KENZIE",
        "middle_name": "DANAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-03",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA14681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.