Individual provider Active NPI

Alice D Thomas, APRN, FNP-C

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1164965695
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP132180 Issued in TX
Practice address
1133 Medical Dr
Tyler, TX 75701-2130
Phone
(903) 595-5486
Fax
(903) 595-5128
NPI assigned
Dec 1, 2016
Last updated
May 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP132180 TX Primary
Family Nurse Practitioner 363LF0000X AP132180 TX

Addresses

Primary practice location

1133 Medical Dr
Tyler, TX 75701-2130

Mailing address

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

Other identifiers 1

IdentifierTypeStateIssuer
368396301MedicaidTX

Other names 1

  • Alice S Udom Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170202002408 TX Practitioner - Nurse Practitioner 5092991240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tyler Nephrology Associates PAGroup PAC ID 6901862242, 27 clinicians

Practice addresses (Care Compare)

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Nephrology Associates, P.a. CurrentSince Jan 23, 2017 Accepting new patients

Locations

1133 Medical Dr
Tyler, TX 75701
Phone 9035955486173

Interoperability endpoints

  • Direct secure messaging: athomas32273@direct.acumenmd.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1164965695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ALICE",
        "middle_name": "D",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-01",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP132180",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP132180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "368396301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICE",
            "last_name": "UDOM",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.