NPIMap

Organization Active NPI

Pinecrest Eye Center, Inc

Doing business as Outpatient Surgisite

  • Ambulatory Surgical Clinic/Center
  • Marshall, TX
National Provider Identifier
1104930411
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
000173 Issued in TX
Legal business name
PINECREST EYE CENTER, INC
Doing business as
Outpatient Surgisite
Practice address
401 E Pinecrest Dr Unit a
Marshall, TX 75670-7207
Phone
(903) 938-8989
Fax
(903) 938-9409
NPI assigned
Aug 17, 2006
Last updated
Aug 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Authorized official

Name
Dr. Marvin Kenneth Hall III, M.D.
Title
Medical Director
Phone
(903) 938-8989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 000173 TX Primary

Addresses

Primary practice location

401 E Pinecrest Dr Unit a
Marshall, TX 75670-7207

Mailing address

405 E Pinecrest Dr Unit a
Marshall, TX 75670-7200
Phone (903) 938-8989

Other identifiers 2

IdentifierTypeStateIssuer
085891201MedicaidTX
HH1313OtherTXBLUE CROSS

Other names 1

  • Outpatient Surgisite Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050502000668 TX Part B Supplier - Ambulatory Surgical Center 3779522404 Practice locations: Marshall, TX

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Pinecrest Eye Center IncCCN 45C0001070
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

401 E Pinecrest Dr
#A
Marshall, TX 75670
Phone (903) 938-8989

405 E Pinecrest Dr
Unit A
Marshall, TX 75670
Phone (903) 938-8581

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1104930411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 E PINECREST DR UNIT A",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756707200",
            "telephone_number": "903-938-8989",
            "fax_number": "903-938-9409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E PINECREST DR UNIT A",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756707207",
            "telephone_number": "903-938-8989",
            "fax_number": "903-938-9409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINECREST EYE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "903-938-8989",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085891201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HH1313",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outpatient Surgisite",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.