Individual provider Active NPI

Michelle Parker, MD

  • Emergency Medicine Physician
  • Tyler, TX
National Provider Identifier
1093153645
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
Q2480 Issued in TX
Practice address
5414 S Broadway Ave
Tyler, TX 75703-1335
Phone
(903) 581-1601
NPI assigned
Jun 5, 2013
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Q2480 TX Primary
Family Medicine Physician 207Q00000X BP10046115 TX
Family Medicine Physician 207Q00000X Q2480 TX

Addresses

Primary practice location

5414 S Broadway Ave
Tyler, TX 75703-1335

Mailing address

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

Other identifiers 9

IdentifierTypeStateIssuer
8FK761OtherTXBCBS
34563511MedicaidTX
345653510MedicaidTX
8LH675OtherTXBCBS
861757OtherTXMEDICARE
P01584101OtherTXRAIL ROAD MEDICARE
861895OtherTXMEDICARE
8FK760OtherTXBCBS
P01587389OtherTXRAIL ROAD MEDICARE

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
I20150406001664 TX Practitioner - Family Practice 8224356183 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians Southwest PAGroup PAC ID 1850204363, 188 clinicians

Practice addresses (Care Compare)

2701 US Hwy 271 N
Pittsburg, TX 75686-4289
Phone (903) 946-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
BP10046115TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince Jul 1, 2016 Accepting new patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Nov 1, 2015 Accepting new patients
Acs Primary Care Physicians Southwest, PA Emergency Medicine CurrentSince Jan 1, 2024 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Nov 1, 2015 Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Jul 1, 2016 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Nov 1, 2015 Accepting new patients
Texas Spine and Joint Hospital, LLC CurrentSince Feb 23, 2015 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Oct 28, 2019 Accepting new patients

Locations

2000 S Palestine St
Athens, TX 75751
Phone (903) 675-2216

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

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

102 W Henderson St
Ste A
Overton, TX 75684
Phone (903) 834-0201

2701 US Highway 271 N
Pittsburg, TX 75686
Phone (903) 946-5000

117 N Winnsboro St
Quitman, TX 75783
Phone (903) 763-4505

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

1814 Roseland Blvd
Tyler, TX 75701
Phone (903) 525-3300

1814 Roseland Blvd
Ste 100
Tyler, TX 75701
Phone (214) 696-8033

5414 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-1601

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

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

Interoperability endpoints

  • Direct secure messaging: mparker355584@ahs.direct-ci.com

Organizations & group practices 8

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.

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": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1093153645",
    "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": "5414 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031335",
            "telephone_number": "903-581-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "MICHELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q2480",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10046115",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "Q2480",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8FK761",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34563511",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345653510",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LH675",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "861757",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01584101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "861895",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8FK760",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01587389",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.