Individual provider Active NPI

Rajani Pathak, PA-C

  • Physician Assistant
  • Killeen, TX
National Provider Identifier
1992277131
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12437 Issued in TX
Practice address
507 W Stan Schlueter Loop
Killeen, TX 76542-3986
Phone
(254) 501-7055
NPI assigned
Dec 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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 PA12437 TX Primary

Addresses

Primary practice location

507 W Stan Schlueter Loop
Killeen, TX 76542-3986

Mailing address

3503 Melony Hill LN
Pearland, TX 77584-6411

Other practice location 1

10130 Louetta Rd Ste L
Houston, TX 77070-2118
Phone (346) 808-3670

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
I20190828001232 TX Practitioner - Physician Assistant 6507194610 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trumen Physician and Associates Post Acute PLLCGroup PAC ID 5496236788, 127 clinicians

Practice addresses (Care Compare)

2626 S Loop W
Suite 265
Houston, TX 77054-5636
Phone (713) 796-9955

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA12437TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Jun 22, 2020 Accepting new patients
Ut Physicians Psychiatry CurrentSince Jun 22, 2020 Accepting new patients
Southlake Doctors Express, PA PSC Current Accepting new patients
MCH Professional Care Past Accepting new patients

Locations

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

2315 E Southlake Blvd
Ste 110
Southlake, TX 76092
Phone (817) 488-9922

Organizations & group practices 9

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": "1545955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585612800000",
    "number": "1992277131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3503 MELONY HILL LN",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775846411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 W STAN SCHLUETER LOOP",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765423986",
            "telephone_number": "254-501-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10130 Louetta Rd Ste L",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770702118",
            "country_code": "US",
            "telephone_number": "346-808-3670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATHAK",
        "first_name": "RAJANI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-28",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.