NPIMap

Organization Active NPI

Deep East Texas Maternal & Family Health PA

Doing business as Complete Healthcare Services PA

  • Family Medicine Physician
  • Jasper, TX
National Provider Identifier
1043307986
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DEEP EAST TEXAS MATERNAL & FAMILY HEALTH PA
Doing business as
Complete Healthcare Services PA
Practice address
315 W Houston St
Jasper, TX 75951-4013
Phone
(409) 384-3430
Fax
(409) 383-0571
NPI assigned
Oct 10, 2006
Last updated
Jun 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Authorized official

Name
Martin E. Gilliland, MDNPI 1376509190
Title
President
Phone
(409) 384-3430

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Adult Health Nurse Practitioner 363LA2200X
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

315 W Houston St
Jasper, TX 75951-4013

Mailing address

315 W Houston St
Jasper, TX 75951-4013
Phone (409) 384-3430

Other identifiers 2

IdentifierTypeStateIssuer
00R88WOtherTXBLUE CROSS/BLUE SHIELD
127285807MedicaidTX

Other names 1

  • Complete Healthcare Services PA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050825000689 TX Part B Supplier - Clinic/Group Practice 7113958539 Receives reassigned benefits from 11 practitioners
Practice locations: Brookeland, TX; Jasper, TX; Silsbee, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1043307986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 W HOUSTON ST",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759514013",
            "telephone_number": "409-384-3430",
            "fax_number": "409-383-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W HOUSTON ST",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759514013",
            "telephone_number": "409-384-3430",
            "fax_number": "409-383-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP EAST TEXAS MATERNAL & FAMILY HEALTH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "GILLILAND",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "409-384-3430",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "00R88W",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127285807",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Healthcare Services PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jasper, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.