Individual provider Active NPI

Ketan Patel, M.D.

  • Pulmonary Disease Physician
  • Tyler, TX
National Provider Identifier
1174721310
Registry record updated Nov 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
N7858 Issued in TX
Practice address
912 S Fleishel Ave
Tyler, TX 75701-2018
Phone
(903) 592-6901
Fax
(903) 595-2571
NPI assigned
Jul 10, 2007
Last updated
Nov 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X N7858 TX
Critical Care Medicine (Internal Medicine) Physician 207RC0200X N7858 TX
Pulmonary Disease Physician 207RP1001X N7858 TX Primary

Addresses

Primary practice location

912 S Fleishel Ave
Tyler, TX 75701-2018

Mailing address

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

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
I20110714000331 TX Practitioner - Critical Care (Intensivists)Practitioner - Pulmonary Disease 1557539798 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pulmonary Disease
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 E 5TH St
Suite 300
Tyler, TX 75701-3333
Phone (903) 590-5080

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

117 N Winnsboro St
Quitman, TX 75783-2144
Phone (903) 763-6220

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

2000 S Palestine St
Athens, TX 75751-5610
Phone (903) 676-1000

2608 McDonald Rd
Tyler, TX 75701-5934
Phone (903) 595-5514

300 Wilson St
Henderson, TX 75652-5956
Phone (903) 655-6536

409 Cottage Rd
Carthage, TX 75633-1466
Phone (903) 694-4790

501 S Ragsdale St
Jacksonville, TX 75766-2434
Phone (903) 541-5143

704 S Palestine St
Athens, TX 75751-3325
Phone (903) 592-6901

709 E Goode St
Quitman, TX 75783-1623

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince May 1, 2020 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince May 1, 2020 Accepting new patients
Tyler Regional Hospital LLC Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

912 S Fleishel Ave
Tyler, TX 75701
Phone 90359269011811

Interoperability endpoints

  • Direct secure messaging: kpatel@psotmd.gwaydirect.com
  • Direct secure messaging: kpatel355041@ahs.direct-ci.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1174721310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-595-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-595-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "KETAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "N7858",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "N7858",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "N7858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.