NPIMap

Individual provider Active NPI

Edward Timothy Okelley, MD

  • Family Medicine Physician
  • Atlanta, TX
National Provider Identifier
1184630212
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G3658 Issued in TX
Practice address
1011 South William
Atlanta, TX 75551-3245
Phone
(903) 796-2868
Fax
(903) 796-0826
NPI assigned
Jul 31, 2006
Last updated
Aug 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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 G3658 TX Primary

Addresses

Primary practice location

1011 South William
Atlanta, TX 75551-3245

Mailing address

PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090601000451 TX Practitioner - Family Practice 1759430317 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Texas Physician Services, PLLCGroup PAC ID 6305295429, 236 clinicians
Pallicare, IncGroup PAC ID 8123429925, 85 clinicians

Practice addresses (Care Compare)

1007 S William St
Atlanta, TX 75551-3245
Phone (903) 799-3000

5803 Stoneridge Dr
Texarkana, TX 75503-1461
Phone (903) 278-5747

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G3658TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pallicare, Inc Family Medicine CurrentSince Dec 18, 2023 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Family Medicine CurrentSince Jun 15, 2015 Accepting new patients
North Texas Physician Services, PLLC CurrentSince Feb 1, 2024 Accepting new patients
Atlanta Hospital Authority Past Accepting new patients
Atlanta Hospital Authority Past Accepting new patients
Christus Health Ark-la-Tex Past Accepting new patients
Chambers County Public Hospital District No 1 Past Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

1007 S William St
Atlanta, TX 75551
Phone (903) 614-2000

3201 W State Highway 22
Corsicana, TX 75110
Phone (903) 654-6800

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Focused Care at LindenLinden, TX, CCN 675293 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2020
Apr 1, 2020

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 8

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1184630212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1326",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756711326",
            "telephone_number": "903-927-3782",
            "fax_number": "903-927-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 SOUTH WILLIAM",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755513245",
            "telephone_number": "903-796-2868",
            "fax_number": "903-796-0826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKELLEY",
        "first_name": "EDWARD",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G3658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, TX

Sources for this page

Verify at the official NPI Registry.