Individual provider Active NPI

Nancy Buettner, PA-C

  • Physician Assistant
  • Longview, TX
National Provider Identifier
1285026559
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA09717 Issued in TX
Practice address
709 Hollybrook Dr Ste 4500
Longview, TX 75605-2412
Phone
(903) 291-6109
Fax
(903) 291-6013
NPI assigned
Feb 24, 2015
Last updated
Aug 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA09717 TX Primary
Medical Physician Assistant 363AM0700X TX

Addresses

Primary practice location

709 Hollybrook Dr Ste 4500
Longview, TX 75605-2412

Mailing address

PO Box 610393
Dallas, TX 75261-0393
Phone (903) 291-6187

Other identifiers 1

IdentifierTypeStateIssuer
344775702MedicaidTX

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150414000403 TX Practitioner - Physician Assistant 3577881085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

707 Hollybrook Dr
Longview, TX 75605-2409

707 Hollybrook Dr
Longview, TX 75605-2410

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Clinicians of East Texas Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nancy.buettner.1@23550.direct.athenahealth.com

Organizations & group practices 2

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 3

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": "1424736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566432000000",
    "number": "1285026559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-291-6187",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HOLLYBROOK DR STE 4500",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052412",
            "telephone_number": "903-291-6109",
            "fax_number": "903-291-6013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUETTNER",
        "first_name": "NANCY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-24",
        "last_updated": "2019-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09717",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344775702",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.