Individual provider Active NPI

Gregory Mallett

  • Certified Registered Nurse Anesthetist
  • Tyler, TX
National Provider Identifier
1093085193
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
826622 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701
Phone
(903) 606-4522
NPI assigned
Jan 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN117800 LA
Certified Registered Nurse Anesthetist 367500000X 826622 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701

Mailing address

PO Box 841656
Dallas, TX 75284-1656

Other practice location 1

800 E Dawson St
Tyler, TX 75701
Phone (903) 606-4522

Other practice location 2

4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-4000

Other identifiers 7

IdentifierTypeStateIssuer
75-2771569-008OtherTXTRICARE
8683UKOtherTXBCBS
P02245621OtherTXMEDICARE RAIL ROAD
314440403MedicaidTX
314440406OtherTXMEDICARE
8JM831OtherTXBCBS
799488OtherTXMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130122000546 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446403646 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia III PAGroup PAC ID 0042630501, 393 clinicians
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 531-8890

3315 S Alameda St
Corpus Christi, TX 78411-1820
Phone (214) 687-0001

7400 Barlite Blvd
San Antonio, TX 78224-1308
Phone (210) 921-2000

800 E Dawson St
Tyler, TX 75701-2036

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN117800LAMDCertified Registered Nurse Anesthetist
826622TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at San Antonio CurrentSince Aug 28, 2023 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Jul 27, 2015 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Oct 20, 2025 Accepting new patients
Northstar Anesthesia III PA Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2025 Accepting new patients
University of Texas Health Science Center at San Antonio Current Accepting new patients
Community Medicine Associates CurrentSince Aug 18, 2023 Accepting new patients
The University of Texas Health Science Center at San Antonio CurrentSince Aug 28, 2023 Accepting new patients
Christus Good Shepherd Medical Center CurrentSince Sep 1, 2017 Accepting new patients
Christus Good Shepherd Medical Center Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Mother Frances Hospital Jacksonville Nurse Anesthetist, Certified Registered CurrentSince Apr 3, 2019 Accepting new patients

Locations

14425 Falcon Head Blvd
#11
Austin, TX 78738
Phone (512) 900-1006

3080 College St
#T
Beaumont, TX 77701
Phone (409) 212-5002

3315 S Alameda St
Corpus Christi, TX 78411
Phone (361) 761-1400

621 N Hall St
Dallas, TX 75226
Phone (214) 820-0600

6949 Bryant Irvin Rd
Ste 110
Ft Worth, TX 76132
Phone (817) 332-1818

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

6800 N MacArthur Blvd
Irving, TX 75039
Phone (972) 969-2000

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

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

4600 E Sam Houston Pkwy S
Pasadena, TX 77505
Phone (713) 853-9302

4000 Spencer Hwy
Pasadena, TX 77504
Phone (713) 359-1000

4502 Medical Dr
San Antonio, TX 78229
Phone (210) 358-3555

903 W Martin St
#492
San Antonio, TX 78207
Phone (210) 358-3441

7703 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 450-3700

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

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

Organizations & group practices 10

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 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": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1093085193",
    "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"
        },
        {
            "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": "75701",
            "telephone_number": "903-606-4522"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E Dawson St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "75701",
            "country_code": "US",
            "telephone_number": "903-606-4522",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-358-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLETT",
        "first_name": "GREGORY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-05",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "RN117800",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "826622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2771569-008",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8683UK",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02245621",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314440403",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "314440406",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8JM831",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "799488",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.