Individual provider Active NPI

Shawn D Pierce, MD

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1023041969
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J4440 Issued in TX
Practice address
833 S Beckham Ave
Tyler, TX 75701-1905
Phone
(903) 780-4396
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X J4440 TX
Family Medicine Physician 207Q00000X J4440 TX Primary

Addresses

Primary practice location

833 S Beckham Ave
Tyler, TX 75701-1905

Mailing address

PO Box 2100
Flint, TX 75762-2100
Phone (903) 780-4396

Other identifiers 1

IdentifierTypeStateIssuer
1119711-09MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040617001003 TX Practitioner - Family PracticePractitioner - Other (Physician) 2365426129 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
J4440TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Human Services Commission Current Accepting new patients
Health and Human Services Commission CurrentSince Sep 1, 2017 Accepting new patients
Marshall Health Services Inc Family Medicine PastSince Sep 1, 2009 Accepting new patients
East Texas Medical Center Healthcare Associates Emergency Medicine Past Accepting new patients

Locations

805 N Dickinson Dr
Rusk, TX 75785
Phone (903) 683-7201

Organizations & group practices 4

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1023041969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2100",
            "city": "FLINT",
            "state": "TX",
            "postal_code": "757622100",
            "telephone_number": "903-780-4396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011905",
            "telephone_number": "903-780-4396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIERCE",
        "first_name": "SHAWN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "J4440",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J4440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1119711-09",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.