NPIMap

Individual provider Active NPI

Yetunde O Balogun, M.D.

  • Vascular Surgery Physician
  • Longview, TX
National Provider Identifier
1306129713
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
V8935 Issued in TX
Practice address
705 E Marshall Ave Ste 5001
Longview, TX 75601-5524
Phone
(903) 315-2777
NPI assigned
Sep 21, 2011
Last updated
Aug 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X V8935 TX Primary
Surgery Physician 208600000X MT200039 PA

Addresses

Primary practice location

705 E Marshall Ave Ste 5001
Longview, TX 75601-5524

Mailing address

3401 N Broad St
Philadelphia, PA 19140-5103

Other practice location 1

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (267) 294-9265

Other practice location 2

707 E Marshall Ave
Longview, TX 75601-5545
Phone (903) 315-5400

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
I20260416001597 TX Practitioner - Vascular Surgery 8729318688 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

700 E Marshall Ave
Christus Trinity Clinic
Longview, TX 75601-5580
Phone (903) 315-1488

703 E Marshall Ave
Longview, TX 75601-5500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)13
Removal of tissue13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT200039PAMDSurgery Physician
V8935TXMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Branch Regional Medical Center Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Sep 1, 2025 Accepting new patients
Mymichigan Medical Center Saginaw Current Accepting new patients
Mymichigan Medical Center Standish CurrentSince Feb 25, 2026 Accepting new patients
Mymichigan Medical Center Saginaw Current Accepting new patients
Mymichigan Medical Center West Branch Current Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 1, 2021 Accepting new patients
Mymichigan Medical Center West Branch CurrentSince Oct 21, 2021 Accepting new patients
Mymichigan Medical Center Tawas Current Accepting new patients
Mymichigan Medical Center Tawas Surgery CurrentSince Sep 1, 2025 Accepting new patients
Mymichigan Medical Center Saginaw CurrentSince Jan 1, 2025 Accepting new patients
Mymichigan Medical Center Saginaw CurrentSince Jan 1, 2025 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 1, 2021 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients
Mymichigan Medical Center Midland Past Accepting new patients
Mymichigan Medical Center Saginaw Past Accepting new patients

Locations

1117 S Van Dyke Rd
Ste 300
Bad Axe, MI 48413

602 Beech St
Ste 2200
Clare, MI 48617
Phone (989) 488-5470

609 Quarter St
Ste 7
Gladwin, MI 48624
Phone (989) 343-1134

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

2660 W Sugnet Rd
#C
Midland, MI 48640
Phone (989) 488-5450

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4701 Towne Centre Rd
Ste 303
Saginaw, MI 48604
Phone (989) 780-2455

4701 Towne Centre Rd
Ste 3
Saginaw, MI 48604
Phone (989) 790-0007

3570 Shattuck Rd
Saginaw, MI 48603
Phone (989) 792-5353

1015 S Washington Ave
Fl 2
Saginaw, MI 48601
Phone (989) 753-5300

805 W Cedar St
Standish, MI 48658
Phone (989) 846-3500

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153

2431 S M 30
Ste 216
West Branch, MI 48661
Phone (989) 343-1134

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Interoperability endpoints

  • Direct secure messaging: ybalogun115288@mymichiganhealth.midirect.net

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 10

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": "1316563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1306129713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E MARSHALL AVE STE 5001",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015524",
            "telephone_number": "903-315-2777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "267-294-9265",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "707 E Marshall Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015545",
            "country_code": "US",
            "telephone_number": "903-315-5400",
            "fax_number": "903-315-2833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALOGUN",
        "first_name": "YETUNDE",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-21",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "V8935",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT200039",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.