Individual provider Active NPI

Everett Dean Holley, MD

  • Emergency Medicine Physician
  • Tyler, TX
National Provider Identifier
1073547782
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
L6065 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 531-4262
NPI assigned
Jul 10, 2006
Last updated
Nov 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X L6065 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000

Other identifiers 19

IdentifierTypeStateIssuer
75-2616977-028OtherTXTRICARE
158367611MedicaidTX
75-0818167022OtherTXTRICARE
P01304462OtherTXRAIL ROAD
158367614MedicaidTX
750818167044OtherTXTRICARE
P00792073OtherTXRAIL ROAD
75-0818167-048OtherTXTRICARE
75-2616977-002OtherTXTRICARE
750818167015OtherTXTRICARE
751976930005OtherTXTRICARE
8X8161OtherTXBCBS
158367610MedicaidTX
75-2616977-01OtherTXTRICARE
8DU752OtherTXBCBS
TIN PLUS 015OtherTXTRICARE
158367612MedicaidTX
158367613MedicaidTX
P00662854OtherTXRAIL ROAD

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
I20040501000126 TX Practitioner - Emergency Medicine 7012905979 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Texas Medical School at Houston, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Texas Emergency Physicians PLLCGroup PAC ID 8527420306, 195 clinicians

Practice addresses (Care Compare)

18780 Interstate 20 N Access Rd
Canton, TX 75103-3593
Phone (903) 567-7748

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L6065TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trincare Inc Current Accepting new patients
Northeast Texas Emergency Physicians, PLLC Emergency Medicine CurrentSince Oct 1, 2023 Accepting new patients
Choice Supportive Care Team Inc. CurrentSince Nov 7, 2019 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 10, 2013 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Sep 1, 2008 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jun 10, 2013 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Sep 1, 2010 Accepting new patients
Cherokee Emergency Medicine Associates PA Emergency Medicine Past Accepting new patients
Upshur Emergency Medicine Associates PA Emergency Medicine Past Accepting new patients
East Texas Medical Center Healthcare Associates Emergency Medicine Past Accepting new patients
Smith Emergency Medicine Associates PA Emergency Medicine Past Accepting new patients
Rusk Emergency Medicine Associates PA Emergency Medicine Past Accepting new patients
Camp Emergency Medicine Associates PA Emergency Medicine Past Accepting new patients
Mother Frances Hospital Winnsboro Past Accepting new patients

Locations

1509 State Highway 19 S
Athens, TX 75751
Phone (903) 606-4262

1007 S William St
Atlanta, TX 75551
Phone (903) 614-2000

18780 Interstate 20 N Access Rd
Canton, TX 75103
Phone (903) 567-4841

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

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

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

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

719 W Coke Rd
Winnsboro, TX 75494
Phone (903) 342-3710

719 W Coke Rd
Ste 4
Winnsboro, TX 75494
Phone (903) 342-3760

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 14

Hospital & facility affiliations 1

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1073547782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841656",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752841656",
            "telephone_number": "903-531-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-531-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLEY",
        "first_name": "EVERETT",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "L6065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-028",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158367611",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167022",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P01304462",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158367614",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "750818167044",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P00792073",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-048",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "750818167015",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "751976930005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8X8161",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158367610",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DU752",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "TIN PLUS 015",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158367612",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158367613",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P00662854",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.