PAULINA PURNAMA (PA-C) – Surgical Physician Assistant, NPI 1275724981
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,491 PHYSICIAN ASSISTANT in TX
Provider Addresses for PAULINA PURNAMA (PA-C)
1149 Keller Pkwy Ste A
Keller, TX 762481620
Phone: (214) 631-9881
Fax: (469) 482-2526
Type: Location
800 12TH AVE STE 200
FORT WORTH, TX 761042519
Phone: (214) 631-9881
Fax: (469) 482-2526
Type: Mailing
2600 E SOUTHLAKE BLVD STE 120-177
SOUTHLAKE, TX 760926634
Phone: (469) 708-3989
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 36 Open Payments records for all available years, with a total value of $2,842.
Total Amount is formed as General ($2,842) + Research ($0) + Ownership ($0) = $2,842.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Pylant Medical ($1,112).
Total Amount
$2,842
General + Research + Ownership
Payments
36
Total payment records
General Amount
$2,842
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Pylant Medical | $1,112 |
| Zimmer Biomet Holdings, Inc. | $701 |
| Stryker Corporation | $187 |
| Miach Orthopaedics, Inc. | $176 |
| Zynex Medical, Inc. | $150 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-05-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170509000883 | I | Physician Assistant | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 76248)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery, Sports Medicine | TX |
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