Beverly K Iltis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA02521 Issued in TX

Practice address

805 Medical Dr
Longview, TX 75605-5130

Phone

(903) 757-6042

Fax

(903) 291-6138

NPI assigned

Mar 1, 2006

Last updated

Nov 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Physician Assistant

Education

Other, 1999

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)

Hospital & facility affiliations

• Onesource Home Care Inc Home health agency, Longview, TX, CCN 679138
• Accentcare Home Health of Texas Home health agency, Longview, TX, CCN 679090
• Longview Regional Medical Center Hospital, Longview, TX, CCN 450702
• Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: beverly.iltis.1@23550.direct.athenahealth.com

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.

• Associated Clinicians of East Texas

  dba Diagnostic Clinic of Longview

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1932640349
  Medicare reassignment Care Compare group
• Associated Clinicians of East Texas

  dba Diagnostic Clinic of Longview

  • Community/Retail Pharmacy
  • Longview, TX
  • NPI 1447451406
  NPD (past)
• Longview Wellness Center Inc

  dba Wellness Pointe

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1255137659
  NPD (past)
• Longview Wellness Center Inc

  dba Wellness Pointe

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
  • NPI 1578369922
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christus Good Shepherd Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1124092036
  Care Compare affiliation
• Longview Medical Center LP

  dba Longview Regional Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1528026267
  Care Compare affiliation
• Onesource Home Care, Inc.

  • Home Health Agency
  • Longview, TX
  • NPI 1104147339
  Care Compare affiliation
• Texas Home Health Skilled Services, LP

  dba AccentCare Home Health of Texas

  • Home Health Agency
  • Longview, TX
  • NPI 1669695722
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1326015074",
    "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": "903-757-6042",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 MEDICAL DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055130",
            "telephone_number": "903-757-6042",
            "fax_number": "903-291-6138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILTIS",
        "first_name": "BEVERLY",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA02521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286521406",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ngoc Tran Bao Huynh, PHARMACIST
• I E Willis Jr DPM PC
• Christopher E Ihionkhan, M.D.
• Omowumi Akhuini Ihionkhan, D.D.S.
• IHS Acquisition No 138 Inc (Heritage at Longview Healthcare Center)
• Impel Ambulance Service, Inc
• Inform Diagnostics, Inc
• Lena Brittany Ingraham, PPCNP-BC, FNP-C
• Domanique Ingram
• Insp

• Physician Assistant in Longview, TX
• Providers in Longview, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.