East Texas Medical Center Healthcare Associates

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES

Practice address

901 Turtle Creek Dr
Tyler, TX 75701

Phone

(903) 596-3555

Fax

(903) 596-3560

NPI assigned

Jun 16, 2006

Organization subpart

No

Name

Rebecca Mangum

Title

VP

Phone

(903) 596-3594

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Neil H Adelman, M.D

  • Addiction Medicine (Internal Medicine) Physician
  • Tyler, TX
  • NPI 1902848120

  Internal Medicine

  NPD
• Margaret Reese Hayden, M.D.

  • Internal Medicine Physician
  • Tyler, TX
  • NPI 1447359385

  Internal Medicine

  NPD
• Randy Craig Randall, MD

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1003847716

  Cardiovascular Disease

  NPD
• Masoud Romezi, MD

  • Internal Medicine Physician
  • Weatherford, TX
  • NPI 1568408375

  Internal Medicine

  NPD
• Guiselle Berry, FNP-C

  • Family Nurse Practitioner
  • Caddo Mills, TX
  • NPI 1184362964
  NPD (past)
• Misty Hallonquist Blalock, NP

  • Family Nurse Practitioner
  • Daingerfield, TX
  • NPI 1114928439
  NPD (past)
• Kirra Nikole Boyter

  • Physician Assistant
  • Forney, TX
  • NPI 1659873198
  NPD (past)
• Kearsty Busby, FNP-C

  • Family Nurse Practitioner
  • Royse City, TX
  • NPI 1255048039
  NPD (past)
• Hector D Ceccoli, MD

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1548250392

  Cardiovascular Disease

  NPD (past)
• Valarie M Chambless, FNP-C

  • Family Nurse Practitioner
  • Canton, TX
  • NPI 1215423397
  NPD (past)
• Lashervia Collins, PA-C

  • Medical Physician Assistant
  • Terrell, TX
  • NPI 1093227852

  Urology

  NPD (past)
• Shelbi Dawn Cooper, FNP

  • Family Nurse Practitioner
  • Winnsboro, TX
  • NPI 1437359601
  NPD (past)

Locations (25 of 41)

• First Physicians Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 11, 2017.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1124062484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9477",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757119477",
            "telephone_number": "903-594-2450",
            "fax_number": "903-939-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-596-3555",
            "fax_number": "903-596-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS MEDICAL CENTER HEALTHCARE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "903-596-3594"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "4278",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130864507",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00T07K",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130864502",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC7791",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD9882",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO DME",
            "identifier": "4944030003",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC6186",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085332701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• East Texas LTC the Waterton at Shiloh LLC
• East Texas Medical Center
• East Texas Medical Center
• East Texas Medical Center Cancer Institute
• East Texas Medical Center Healthcare Associates
• East Texas Medical Center Healthcare Associates
• East Texas Medical Center Healthcare Associates
• East Texas Medical Center Healthcare Associates
• East Texas Medical Center Healthcare Associates
• East Texas Medical Center Healthcare Associates

• All providers in Tyler, TX
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.