Active NPI
Micheal C Mendez, P.A.
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1952647422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA07924
- Practice address
- 546 W Seminary Dr Ste a
Fort Worth, TX 76115-1361 - Phone
- (817) 924-7978
- NPI assigned
- Jan 2, 2013
- Last updated
- Mar 9, 2022
- 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 | PA07924 | TX | Primary |
Addresses
Primary practice location
546 W Seminary Dr Ste a
Fort Worth, TX 76115-1361
Mailing address
546 W Seminary Dr Ste a
Fort Worth, TX 76115-1361
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3550519-02 | Medicaid | TX |
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, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
546 W Seminary Dr
Suite a
Fort Worth, TX 76115-1361
Phone (817) 924-7978
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Southside Medical Clinic
- Family Medicine Physician
- Fort Worth, TX
- NPI 1043331812
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646784000000",
"number": "1952647422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "546 W SEMINARY DR STE A",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761151361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "546 W SEMINARY DR STE A",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761151361",
"telephone_number": "817-924-7978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDEZ",
"first_name": "MICHEAL",
"middle_name": "C",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-02",
"last_updated": "2022-03-09",
"certification_date": "2022-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA07924",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3550519-02",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.