NPIMap

Individual provider Active NPI

Spencer Shastid, DO

  • Internal Medicine Physician
  • Tyler, TX
National Provider Identifier
1093336695
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
U1378 Issued in TX
Practice address
2737 S Broadway Ave
Tyler, TX 75701-5445
Phone
(903) 592-6000
Fax
(903) 592-3224
NPI assigned
May 5, 2020
Last updated
Jan 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X U1378 TX Primary
Hospitalist Physician 208M00000X U1378 TX

Addresses

Primary practice location

2737 S Broadway Ave
Tyler, TX 75701-5445

Mailing address

PO Box 6971
Lincoln, NE 68506-0971
Phone (877) 845-2038

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230814001623 TX Practitioner - Internal MedicinePractitioner - Hospitalist 7416388707 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians
Charles R Gordon MD PAGroup PAC ID 8729992052, 24 clinicians

Practice addresses (Care Compare)

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

2737 S Broadway Ave
Tyler, TX 75701-5413
Phone (903) 592-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Aug 1, 2023 Accepting new patients
Etmc Physician Group Inc. CurrentSince Aug 1, 2023 Accepting new patients
Charles R Gordon MD PA CurrentSince Feb 1, 2026 Accepting new patients
Charles R Gordon MD PA CurrentSince Feb 1, 2026 Accepting new patients
Starks Medical Past Accepting new patients
Precision Surgery Center, LLC. Past Accepting new patients

Locations

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

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

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

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: sshastid255585@christushealth.direct-ci.net
  • Direct secure messaging: sshastid355736@ahs.direct-ci.com

Organizations & group practices 6

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 4

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": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769558400000",
    "number": "1093336695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6971",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685060971",
            "telephone_number": "877-845-2038",
            "fax_number": "866-353-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757015445",
            "telephone_number": "903-592-6000",
            "fax_number": "903-592-3224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHASTID",
        "first_name": "SPENCER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-05",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "U1378",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "U1378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.