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KATHRYN ELISE QUINTANILLA PA-C
NPI 1104526862
Physician Assistant in Fort Worth, TX

Active since March 09, 2023Opted out of Medicare · through Jan 9, 2028
4927 BYERS AVENUE, FORT WORTH, TX 76107(817) 994-2655 Get Directions Write a Review

NPPES record last updated: April 26, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kathryn Elise Quintanilla Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHRYN ELISE QUINTANILLA PA-C (NPI 1104526862) is an individual physician assistant in Fort Worth, Texas, licensed in Texas (PA16705) and active in the NPI registry since March 2023. She has opted out of Medicare through January 9, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1104526862
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameKATHRYN ELISE QUINTANILLACredential: PA-C
Location Address4927 BYERS AVENUEFort Worth, TX 76107
Mailing Address4927 Byers AvenueFort Worth, TX 76107
Phone(817) 994-2655
Sole ProprietorNo
Enumeration DateMarch 9, 2023
Last NPPES UpdateApril 26, 2023
NPPES CertifiedApril 26, 2023
✔ NPI 1104526862 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in TX · PA16705
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
4927 BYERS AVENUE, Fort Worth, TX 76107
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Kathryn Elise Quintanilla Pa-c has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 9, 2026 through January 9, 2028.

Opt-Out Effective DateJanuary 9, 2026
Opt-Out In Effect ThroughJanuary 9, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.20 typical visit price
range $56.47 – $171.07
Typical copayment $21.80 (range $14.11 – $42.76)
Most-billed visit code 99203
Established Patient
$70.45 typical visit price
range $18.18 – $139.68
Typical copayment $17.61 (range $4.54 – $34.92)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DABNEY POORTER FNP-C
Family Medicine
4927 BYERS AVENUE
FORT WORTH, TX 76107
Tarrant County (817) 565-9667

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathryn Quintanilla's NPI number?

The NPI number for Kathryn Quintanilla is 1104526862. It was assigned to this individual provider in the NPPES registry on March 9, 2023.

Where is Kathryn Quintanilla located?

Kathryn Quintanilla practices at 4927 Byers Avenue, Fort Worth, TX 76107. The listed phone number is (817) 994-2655.

What is Kathryn Quintanilla's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kathryn Quintanilla enrolled in Medicare?

No. Kathryn Quintanilla has opted out of Medicare through January 9, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Kathryn Quintanilla was last updated on April 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.