Individual provider Active NPI

James A Lively, MD

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1043284938
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K5606 Issued in TX
Practice address
3802 Manhatton Dr
Tyler, TX 75701-9451
Phone
(903) 509-8888
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K5606 TX Primary

Addresses

Primary practice location

3802 Manhatton Dr
Tyler, TX 75701-9451

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450

Other identifiers 1

IdentifierTypeStateIssuer
117659605MedicaidTX

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
I20100217000559 TX Practitioner - Family Practice 4880738699 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Jul 1, 2000 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2000 Accepting new patients
Trinity Clinic Family Medicine Past Accepting new patients
Tyler Rehab Associates, L.P. Past Accepting new patients

Locations

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

3802 Manhatton Dr
Tyler, TX 75701
Phone (903) 509-8888

3131 Troup Hwy
Tyler, TX 75701
Phone (903) 510-7000

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

Interoperability endpoints

  • Direct secure messaging: jlively6677@christushealth.direct-ci.net

Organizations & group practices 6

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413158400000",
    "number": "1043284938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 MANHATTON DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019451",
            "telephone_number": "903-509-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVELY",
        "first_name": "JAMES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2014-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K5606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117659605",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.