PHYSICIAN ASSISTANT SERVICES OF TEXAS L.L.P – Medical Physician Assistant, NPI 1164467692
Medical Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PHYSICIAN ASSISTANT SERVICES OF TEXAS L.L.P
PO BOX 93175
SOUTHLAKE, TX 760921175
Phone: (972) 280-0080
Fax: (972) 280-0081
Type: Mailing
Medical City Fort Worth, 900, 8th Avenue, Fort Worth, Tarrant County, Texas, 76104, United States
FORT WORTH, TX 761043902
Phone: (972) 599-0080
Fax: (972) 599-0082
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: 2004-03-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-04-30 (40 days ago).
Enrollment records
1
Earliest due date
2026-04-30
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 |
|---|---|---|---|---|
| O20040322001761 | O | Clinic/Group Practice | TX | 2026-04-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 76092)
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