Individual provider Active NPI

David Brent Kerns, MD

  • Vascular Surgery Physician
  • Tyler, TX
National Provider Identifier
1073515565
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
K0862 Issued in TX
Practice address
1040 S Fleishel Ave
Tyler, TX 75701-2031
Phone
(903) 533-8702
Fax
(903) 533-8720
NPI assigned
Aug 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X K0862 TX
Vascular Surgery Physician 2086S0129X K0862 TX Primary

Addresses

Primary practice location

1040 S Fleishel Ave
Tyler, TX 75701-2031

Mailing address

1040 S Fleishel Ave
Tyler, TX 75701-2031
Phone (903) 533-8702

Other identifiers 6

IdentifierTypeStateIssuer
770001111OtherTXRAILROAD MEDICARE
MDK0862OtherTXTEXAS WORKERS COMP / IHC
045355701MedicaidTX
3292271OtherTXBLUELINK
5849465OtherTXAETNA
86Z401OtherTXBCBS TX

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
I20110124000463 TX Practitioner - Vascular SurgeryPractitioner - General Surgery 4880873892 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
University of Texas Southwestern Medical School at Dallas, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Tyler, TX, CCN 459457
  • Enhabit Home Health Home health agency, Longview, TX, CCN 679079
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • University of Texas Health Science Center at Tyler Hospital, Tyler, TX, CCN 450690
  • Ut Health East Texas Athens Hospital Hospital, Athens, TX, CCN 450389
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal41
Leg revascularization (restoring blood flow)41
Removal of tissue17
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K0862TXMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Robbins MD PA Surgery CurrentSince Oct 18, 2021 Accepting new patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2024 Accepting new patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2024 Accepting new patients
East Texas Medical Center Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

1002 N Mound St
Nacogdoches, TX 75961
Phone (936) 560-3800

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

6210 S Broadway Ave
Tyler, TX 75703
Phone (903) 579-2700

1040 S Fleishel Ave
Tyler, TX 75701
Phone (903) 533-8702

2401 Sse Loop 323
Tyler, TX 75701
Phone (903) 510-7212

700 Olympic Plaza Cir
Ste 510
Tyler, TX 75701
Phone (903) 595-2636

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.

Hospital & facility affiliations 7

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1073515565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012031",
            "telephone_number": "903-533-8702",
            "fax_number": "903-533-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012031",
            "telephone_number": "903-533-8702",
            "fax_number": "903-533-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERNS",
        "first_name": "DAVID",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "K0862",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "K0862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "770001111",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS WORKERS COMP / IHC",
            "identifier": "MDK0862",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045355701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUELINK",
            "identifier": "3292271",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5849465",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TX",
            "identifier": "86Z401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.