Active NPI
Diana Katherine Clark-McGill, PA
- Physician Assistant
- Kingwood, TX
National Provider Identifier
1922093319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00395
- Practice address
- 1450 Kingwood Dr
Kingwood, TX 77339-3040 - Phone
- (832) 548-4420
- NPI assigned
- Sep 13, 2005
- Sex
- Female
- 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 | PA00395 | TX | Primary |
Addresses
Primary practice location
1450 Kingwood Dr
Kingwood, TX 77339-3040
Mailing address
1450 Kingwood Dr
Kingwood, TX 77339-3040
Phone (832) 548-4420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89N545 | Other | TX | BLUE CROSS BLUE SHIELD |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10422 Research Forest Dr
Magnolia, TX 77354-6155
Phone (832) 702-7699
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00395 | TX | MD | Physician Assistant |
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
- Magnolia, TX
- NPI 1093251860
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592524800000",
"number": "1922093319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 KINGWOOD DR",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773393040",
"telephone_number": "832-548-4420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 KINGWOOD DR",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773393040",
"telephone_number": "832-548-4420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK-MCGILL",
"first_name": "DIANA",
"middle_name": "KATHERINE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-13",
"last_updated": "2020-06-19",
"certification_date": "2020-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA00395",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "89N545",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.