NPIMap

Individual provider Active NPI

Sujatha Abraham White, MD

  • Internal Medicine Physician
  • Tyler, TX
National Provider Identifier
1184649691
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
K1329 Issued in TX
Practice address
1100 S Beckham Ave
Tyler, TX 75701-3301
Phone
(903) 596-3500
Fax
(903) 596-3536
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X K1329 TX Primary

Addresses

Primary practice location

1100 S Beckham Ave
Tyler, TX 75701-3301

Mailing address

PO Box 9477
Tyler, TX 75711-9477
Phone (903) 594-2450

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
I20081124000111 TX Practitioner - Internal Medicine 1951477801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1996
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)

2210 Three Lakes Pkwy
Suite 100
Tyler, TX 75703-0642
Phone (903) 747-4050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K1329TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Starks Medical Past Accepting new patients
East Texas Medical Center Past Accepting new patients
Suji White MD PA Internal Medicine PastSince Aug 1, 2008 Accepting new patients

Locations

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

2210 Three Lakes Pkwy
Ste 100
Tyler, TX 75703
Phone (903) 747-4050

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Interoperability endpoints

  • Direct secure messaging: swhite355091@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 9

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1184649691",
    "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": "903-509-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013301",
            "telephone_number": "903-596-3500",
            "fax_number": "903-596-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "SUJATHA",
        "middle_name": "ABRAHAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K1329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.