Candice Roseanne Pellegrino, M.P.A.C., P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA01105 Issued in TX

Practice address

302 University Blvd
Round Rock, TX 78665-1032

Phone

(512) 509-0200

NPI assigned

Jul 26, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Lieber-Moore Cardiology Associates PA

  • Cardiovascular Disease Physician
  • Kingwood, TX
  • NPI 1487669248
  Medicare reassignment
• Psychiatry of Texas PLLC

  • Psychiatry Physician
  • Houston, TX
  • NPI 1013476027
  Medicare reassignment
• Psychplus Medical Associates, PLLC

  • Family Medicine Physician
  • Houston, TX
  • NPI 1558118026
  Medicare reassignment
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1922022938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Medical Cir",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754822138",
            "country_code": "US",
            "telephone_number": "903-438-8330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLEGRINO",
        "first_name": "CANDICE",
        "middle_name": "ROSEANNE",
        "name_prefix": "Ms.",
        "credential": "M.P.A.C., P.A.-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01105",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA01105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGENCY (BVCAA, INC.) NPI",
            "identifier": "1821185299",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lynn Ulrich Peckham, D.O.
• Russell Peckham, DO
• Pediatric Center of Round Rock
• Terry Scott Peery, DO
• Daniel Pelaez
• Jennifer Peloquin, LMFT
• Angela Michelle Pena, APRN, FNP-BC
• Brianna Pena
• Evelyn Cristel Pena
• Jose Pena, LAC, MAOM, DACM

• Medical Physician Assistant in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.