Active NPI
Kenneth D Cushman, MD
- Family Medicine Physician
- Tyler, TX
National Provider Identifier
1275506016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- E9483
- Practice address
- 520 East Douglas Blvd
Tyler, TX 75702 - Phone
- (903) 593-1721
- NPI assigned
- Feb 10, 2006
- Last updated
- Oct 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E9483 | TX | Primary |
Addresses
Primary practice location
520 East Douglas Blvd
Tyler, TX 75702
Mailing address
PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129526304 | Medicaid | TX | |
| 123043 | Other | TX | CHIPS |
| 4540308 | Other | TX | AETNA |
| 752616977048 | Other | TX | TRICARE CHAMPUS |
| CU083Y750 | Other | TX | BCBS |
| 080078392 | Other | TX | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E9483 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413158400000",
"number": "1275506016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 846098",
"city": "DALLAS",
"state": "TX",
"postal_code": "752846098",
"telephone_number": "903-324-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 EAST DOUGLAS BLVD",
"city": "TYLER",
"state": "TX",
"postal_code": "75702",
"telephone_number": "903-593-1721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSHMAN",
"first_name": "KENNETH",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2014-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "E9483",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "129526304",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIPS",
"identifier": "123043",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4540308",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE CHAMPUS",
"identifier": "752616977048",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "CU083Y750",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "080078392",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.