NPIMap

Organization Active NPI

Collom & Carney Clinic Association

Doing business as Collom and Carney Clinic

  • Hematology & Oncology Physician
  • Texarkana, TX
National Provider Identifier
1114909934
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
COLLOM & CARNEY CLINIC ASSOCIATION
Doing business as
Collom and Carney Clinic
Practice address
5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone
(903) 614-3000
Fax
(903) 614-3525
NPI assigned
Nov 17, 2005
Last updated
Jul 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLOM AND CARNEY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

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

Authorized official

Name
Roger A Hall
Title
Ceo Administrator
Phone
(903) 614-3281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X TX Primary

Addresses

Primary practice location

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766

Mailing address

5002 Cowhorn Creek Rd
Texarkana, TX 75503-9766
Phone (903) 614-3000

Other identifiers 2

IdentifierTypeStateIssuer
CU0435OtherRAILROAD MEDICARE
119849104MedicaidTX

Other names 1

  • Collom and Carney Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031226000046 TX Part B Supplier - Clinic/Group Practice 1355249541 Receives reassigned benefits from 48 practitioners
20 other NPIs on this enrollment
Practice locations: Texarkana, TX; Atlanta, TX; New Boston, TX

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Part of
Collom Carney Clinic

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Onesource Home Care IncLongview, TX, CCN 679138 Home health agency 5% Or Greater Indirect Ownership Interest (33.33%) Jun 1, 2020
Prime Care Hospice LLCLongview, TX, CCN 741756 Hospice 5% Or Greater Direct Ownership Interest (33.3%) Jul 19, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 80

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.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1114909934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "903-614-3000",
            "fax_number": "903-614-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOM & CARNEY CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLOM AND CARNEY CLINIC",
        "enumeration_date": "2005-11-17",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO ADMINISTRATOR",
        "authorized_official_telephone_number": "903-614-3281"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CU0435",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119849104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collom and Carney Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

Verify at the official NPI Registry.