NPIMap

Individual provider Active NPI

R Kent Vandergriff, ACNP

  • Critical Care Medicine Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1215230586
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X
License
631043 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 525-1914
NPI assigned
Dec 8, 2010
Last updated
Oct 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 631043 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000

Other identifiers 3

IdentifierTypeStateIssuer
835N41OtherTXBCBS
TIN PLUS 042OtherTXTRICARE
280002101MedicaidTX

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
I20110404000539 TX Practitioner - Nurse Practitioner 1254515935 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Texas Intensivists, PLLCGroup PAC ID 5092167528, 48 clinicians

Practice addresses (Care Compare)

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
631043TXMDCritical Care Medicine Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Physician Services, PLLC CurrentSince May 23, 2024 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jan 17, 2011 Accepting new patients
Northeast Texas Intensivists, PLLC CurrentSince Apr 1, 2024 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC CurrentSince Mar 3, 2017 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jan 17, 2011 Accepting new patients
Sound Inpatient Physicians of Texas I, Inc CurrentSince Aug 1, 2018 Accepting new patients
Sound Inpatient Physicians of Texas I, Inc CurrentSince Aug 1, 2018 Accepting new patients

Locations

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

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

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

17500 W Grand Pkwy S
Sugar Land, TX 77479
Phone (281) 725-5000

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

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

800 E Dawson St
Fl 4
Tyler, TX 75701
Phone (903) 531-4080

Interoperability endpoints

  • Direct secure messaging: rvandergriff20402@christushealth.direct-ci.net

Organizations & group practices 7

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": "1291766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1215230586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841656",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752841656",
            "telephone_number": "903-531-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-525-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERGRIFF",
        "first_name": "R",
        "middle_name": "KENT",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-08",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "TX",
            "license": "631043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "835N41",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "TIN PLUS 042",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280002101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.