NPIMap

Individual provider Active NPI

Mark R Anderson, MD

  • Emergency Medicine Physician
  • Tyler, TX
National Provider Identifier
1346289055
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
J0423 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 593-8441
NPI assigned
Jun 6, 2006
Last updated
Jul 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X J0423 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 19

IdentifierTypeStateIssuer
0061EKOtherTXBCBS
990014514OtherTXRAIL ROAD
015OtherTXTRICARE
130578107MedicaidTX
75-2616977-002OtherTXTRICARE
130578103MedicaidTX
8L1047OtherTXBCBS
130578110MedicaidTX
75-2616977-028OtherTXTRICARE
750818167-044OtherTXTRICARE
P01464103OtherTXRAIL ROAD MEDICARE
005OtherTXTRICARE
75-0818167-048OtherTXTRICARE
130578108MedicaidTX
130578109MedicaidTX
75-2616977-001OtherTXTRICARE
750818167022OtherTXTRICARE
8DQ330OtherTXBCBS
8EX117OtherTXBCBS

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
I20080912000046 TX Practitioner - Emergency Medicine 8224104492 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Apr 1, 2015 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Sep 1, 2008 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Apr 1, 2015 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Sep 1, 2008 Accepting new patients
Mother Frances Hospital Past Accepting new patients
Mother Frances Hospital Winnsboro Past Accepting new patients

Locations

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

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

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

8389 S Broadway Ave
Tyler, TX 75703
Phone (903) 606-4129

719 W Coke Rd
Ste 4
Winnsboro, TX 75494
Phone (903) 342-3760

Interoperability endpoints

  • Direct secure messaging: manderson3306@christushealth.direct-ci.net

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Christus Shreveport-Bossier Health SystemShreveport, LA, CCN 190041 Hospital Corporate Director May 1, 2024
Christus St. Michael Health SystemTexarkana, TX, CCN 450801 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital TylerTyler, TX, CCN 450102 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital - JacksonvilleJacksonville, TX, CCN 451319 Hospital Corporate Director Jan 1, 2021
Christus Inpatient Rehabilitation Center Shreveport-BossierShreveport, LA, CCN 19T041 Hospital Corporate Director May 1, 2024
Christus Good Shepherd Medical CenterLongview, TX, CCN 450032 Hospital Corporate Director Jan 1, 2021
Christus Good Shepherd Medical CenterLongview, TX, CCN 45T032 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital - WinnsboroWinnsboro, TX, CCN 451381 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital - WinnsboroWinnsboro, TX, CCN 45Z381 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital - JacksonvilleJacksonville, TX, CCN 45Z319 Hospital Corporate Director Jan 1, 2021
Christus Mother Frances Hospital - Sulphur SpringsSulphur Springs, TX, CCN 45T236 Hospital Corporate Director Jul 12, 2016
Christus Mother Frances Hospital-Sulphur SpringsSulphur Springs, TX, CCN 450236 Hospital Corporate Director Jul 12, 2016
Christus St Michael Rehabilitation HospitalTexarkana, TX, CCN 45T801 Hospital Corporate Director Jan 1, 2021
Christus Health-PalestinePalestine, TX, CCN 670350 Hospital Corporate Director Jan 1, 2021

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1346289055",
    "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": "903-593-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "J0423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0061EK",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "990014514",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "015",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130578107",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-002",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130578103",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8L1047",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130578110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-028",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "750818167-044",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01464103",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-048",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130578108",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130578109",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "750818167022",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DQ330",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EX117",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.