NOAH SANDUSKY – Physician Assistant, NPI 1790534477

NOAH SANDUSKY is a healthcare provider. based in Fort worth, Texas. specializing in PHYSICIAN ASSISTANT. They hold a License No. PA17985 (TX). The NPI Number for NOAH SANDUSKY is 1790534477

Main info

Male
Sole Proprietor
2 Years Of Experience
Accepts Medicare Assignment
Name
NOAH SANDUSKY
NPI
1790534477
Phone
Not provided
Address
3500 CAMP BOWIE BLVD
Enumeration Date
15 May 2024
Last Update Date
21 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9156528626
Graduation Year
2024 (2 years ago)
PAC ID
0345784625
Group Practice PAC ID
8628062320
Professional Enrollment ID
I20240627001390
Address ID
TX797520000MC2500XSXXX400
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

8,497 PHYSICIAN ASSISTANT in TX

Provider Addresses for NOAH SANDUSKY

  • 3500 CAMP BOWIE BLVD

    FORT WORTH, TX 761072644

    Phone:

    Type: Mailing

  • 2500 HWY 305

    MCCAMEY, TX 79752

    Phone: (432) 652-8626

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2024-06-27

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240627001390IPhysician AssistantTXTBD

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.

Verify on CMS Revalidation Lookup Tool

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 76107)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628062320View full group profile
NameSpecialtyState
-TX
Physician AssistantTX
Nurse PractitionerTX
Nurse PractitionerTX

Reviews

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Frequently asked questions

What is NOAH SANDUSKY's NPI number?
NOAH SANDUSKY's NPI is 1790534477 — the number used across U.S. healthcare to identify this provider.
Active or inactive — what applies to NOAH SANDUSKY?
You should see NOAH SANDUSKY as active in CMS-hosted NPPES data.
How would a patient describe NOAH SANDUSKY's focus?
For NOAH SANDUSKY, the primary taxonomy reads as Physician Assistant. Clinical services aligned with this taxonomy classification.
What locale is associated with NOAH SANDUSKY?
Directory geography for NOAH SANDUSKY centers on Fort Worth, Texas.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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