Individual provider Active NPI

Shanique Malone, MPAS, PA-C

  • Physician Assistant
  • Houston, TX
National Provider Identifier
1992029953
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06485 Issued in TX
Practice address
4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224
Phone
(713) 402-7824
Fax
(713) 570-0196
NPI assigned
Mar 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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 PA06485 TX Primary

Addresses

Primary practice location

4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224

Mailing address

4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224
Phone (713) 402-7824

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
I20120713000087 TX Practitioner - Physician Assistant 9335304575 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

San Antonio, TX 78257
Phone (210) 617-4706

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA06485TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baylor College of Medicine CurrentSince Jun 18, 2012 Accepting new patients
Wellmed Medical Group, PA CurrentSince May 1, 2023 Accepting new patients
Baylor College of Medicine CurrentSince Jun 18, 2012 Accepting new patients

Locations

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

4700 W Sam Houston Pkwy N
Ste 220
Houston, TX 77041
Phone (713) 402-7824

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

19500 Ih 10 W
San Antonio, TX 78257
Phone (888) 781-9355

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

19500 Ih 10 W
#15030
San Antonio, TX 78257
Phone (210) 617-4607

Interoperability endpoints

  • Direct secure messaging: shanique.malone@wellmed.eclinicaldirectplus.com

Organizations & group practices 3

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": "1268956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1992029953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W SAM HOUSTON PKWY N STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418224",
            "telephone_number": "713-402-7824",
            "fax_number": "713-570-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W SAM HOUSTON PKWY N STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418224",
            "telephone_number": "713-402-7824",
            "fax_number": "713-570-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALONE",
        "first_name": "SHANIQUE",
        "name_prefix": "Ms.",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-19",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.