Individual provider Active NPI

Xochitl S Bockmon, PA

  • Physician Assistant
  • La Porte, TX
National Provider Identifier
1891811360
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA03920 Issued in TX
Practice address
404 W Fairmont Pkwy
La Porte, TX 77571-6308
Phone
(281) 470-6060
Fax
(281) 470-7284
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 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 PA03920 TX Primary

Addresses

Primary practice location

404 W Fairmont Pkwy
La Porte, TX 77571-6308

Mailing address

404 W Fairmont Pkwy
La Porte, TX 77571-6308
Phone (281) 470-6060

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
I20151105002649 TX Practitioner - Physician Assistant 4183934946 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Group, PA CurrentSince Mar 20, 2023 Accepting new patients

Locations

10611 W Fairmont Pkwy
La Porte, TX 77571
Phone (281) 470-4700

404 W Fairmont Pkwy
La Porte, TX 77571
Phone (281) 470-6060

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

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.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1891811360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W FAIRMONT PKWY",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "775716308",
            "telephone_number": "281-470-6060",
            "fax_number": "281-470-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W FAIRMONT PKWY",
            "city": "LA PORTE",
            "state": "TX",
            "postal_code": "775716308",
            "telephone_number": "281-470-6060",
            "fax_number": "281-470-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCKMON",
        "first_name": "XOCHITL",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Porte, TX

Sources for this page

Verify at the official NPI Registry.