NPIMap

Individual provider Active NPI

Kyle Groom, D.O.

  • Family Medicine Physician
  • De Kalb, TX
National Provider Identifier
1063413656
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L5749 Issued in TX
Practice address
216 N Centre St
De Kalb, TX 75559-1406
Phone
(903) 667-2273
Fax
(903) 667-7597
NPI assigned
Aug 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L5749 TX Primary
Emergency Medicine Physician 207P00000X L5749 TX

Addresses

Primary practice location

216 N Centre St
De Kalb, TX 75559-1406

Mailing address

216 N Centre St
De Kalb, TX 75559-1406
Phone (903) 667-2273

Other practice location 1

5904 Summerfield Dr
Texarkana, TX 75503-4306
Phone (430) 200-4350

Other practice location 2

3002 Moores Ln
Texarkana, TX 75503-2204
Phone (430) 200-4350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040330001205 TX Practitioner - Emergency MedicinePractitioner - Family Practice 2264424456 Reassigns benefits to 3 organizations
I20200629002097 OK Practitioner - Emergency MedicinePractitioner - General Practice 2264424456

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dekalb Physicians Clinic LLCGroup PAC ID 0244264216, 3 clinicians
Midsouth Transitions Medical GroupGroup PAC ID 8628322831, 17 clinicians

Practice addresses (Care Compare)

216 N Centre St
Dekalb Phyisians Clinic
Dekalb, TX 75559-1406
Phone (903) 667-2273

5904 Summerfield Dr
Texarkana, TX 75503-4306
Phone (430) 200-4350

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L5749TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dekalb Physicians Clinic LLC Family Medicine CurrentSince May 19, 2005 Accepting new patients
East Texas Medical Services PLLC Emergency Medicine CurrentSince Jul 15, 2024 Accepting new patients
Emergency Associates of Texas, PA Emergency Medicine Past Accepting new patients
Southcrest Emergency Physicians PC Past Accepting new patients
Mayes County Hma, LLC Past Accepting new patients
Texarkana Emergency Medicine Physicians,PA Emergency Medicine Past Accepting new patients

Locations

216 N Centre St
De Kalb, TX 75559
Phone (903) 667-2273

2001 N Jefferson Ave
Mt Pleasant, TX 75455
Phone (903) 434-8044

Organizations & group practices 7

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1063413656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 N CENTRE ST",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755591406",
            "telephone_number": "903-667-2273",
            "fax_number": "903-667-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N CENTRE ST",
            "city": "DE KALB",
            "state": "TX",
            "postal_code": "755591406",
            "telephone_number": "903-667-2273",
            "fax_number": "903-667-7597"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5904 Summerfield Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755034306",
            "country_code": "US",
            "telephone_number": "430-200-4350",
            "fax_number": "833-491-2722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3002 Moores Ln",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755032204",
            "country_code": "US",
            "telephone_number": "430-200-4350",
            "fax_number": "833-491-2722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROOM",
        "first_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L5749",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L5749",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Kalb, TX

Sources for this page

Verify at the official NPI Registry.