Active NPI
Edward Maxwell, PA
- Physician Assistant
- San Antonio, TX
National Provider Identifier
1972515831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01907
- Practice address
- 4800 Fredericksburg Rd
Suite 127
San Antonio, TX 78229-3628 - Phone
- (210) 733-5072
- Fax
- (210) 733-8649
- NPI assigned
- Aug 12, 2006
- Last updated
- May 20, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01907 | TX | Primary |
| Medical Physician Assistant | 363AM0700X | PA01907 | TX |
Addresses
Primary practice location
4800 Fredericksburg Rd
Suite 127
San Antonio, TX 78229-3628
Mailing address
PO Box 1239
Troy, MI 48099-1239
Phone (248) 824-6600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191882301 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01907 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The University of Texas Health Science Center at San Antonio | Past | Accepting new patients | |
| Texan Urgent Care PLLC | Past | 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.
-
dba UT Health San Antonio Multispecialty & Research Hospital
- General Acute Care Hospital
- San Antonio, TX
- NPI 1326829904
-
dba FastMed Urgent Care
- Emergency Medicine Physician
- Scottsdale, AZ
- NPI 1346545209
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1972515831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1239",
"city": "TROY",
"state": "MI",
"postal_code": "480991239",
"telephone_number": "248-824-6600",
"fax_number": "248-324-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 FREDERICKSBURG RD",
"address_2": "SUITE 127",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782293628",
"telephone_number": "210-733-5072",
"fax_number": "210-733-8649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXWELL",
"first_name": "EDWARD",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-12",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01907",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA01907",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "191882301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.