Individual provider Active NPI

Mark H Gibby, M.D.

  • Family Medicine Physician
  • Gatesville, TX
National Provider Identifier
1104973304
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2448 Issued in TX
Practice address
1507 W Main St
Gatesville, TX 76528-1024
Phone
(254) 865-2166
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2448 TX Primary

Addresses

Primary practice location

1507 W Main St
Gatesville, TX 76528-1024

Mailing address

1507 W Main
Gatesville, TX 76528
Phone (254) 865-2166

Other identifiers 1

IdentifierTypeStateIssuer
003714900MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Dr.MGibby@cmhs.securechart.com Direct

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
I20120802000640 TX Practitioner - Family Practice 5294912663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coryell County Memorial Hospital AuthorityGroup PAC ID 7719886282, 39 clinicians

Practice addresses (Care Compare)

1507 W Main St
Gatesville, TX 76528-1098
Phone (254) 865-8251

Hospital & facility affiliations

  • Coryell Memorial Hospital Hospital, Gatesville, TX, CCN 451379

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2448TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hero Medical Services, PLLC Current Accepting new patients
Coryell County Memorial Hospital Authority CurrentSince Apr 21, 2012 Accepting new patients
Coryell County Memorial Hospital Authority Current Accepting new patients
Coryell County Memorial Hospital Authority CurrentSince Apr 21, 2012 Accepting new patients
Preston Family Medicine Family Medicine PastSince Jul 1, 1991 Accepting new patients

Locations

1507 W Main St
Gatesville, TX 76528
Phone (254) 865-8251

Interoperability endpoints

  • Direct secure messaging: dr.mgibby@cmhs.securechart.com
  • Direct secure messaging: drmgibby@cmhs.securechart.com

Organizations & group practices 5

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1104973304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 W MAIN",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "76528",
            "telephone_number": "254-865-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 W MAIN ST",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "765281024",
            "telephone_number": "254-865-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBY",
        "first_name": "MARK",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "2448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003714900",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Dr.MGibby@cmhs.securechart.com",
            "affiliation": "N",
            "endpointDescription": "Coryell Health Direct Messaging Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1507 W Main St",
            "city": "Gatesville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765281024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gatesville, TX

Sources for this page

Verify at the official NPI Registry.