Individual provider Active NPI

Kyle Patrick Urbanek

  • Family Nurse Practitioner
  • Longview, TX
National Provider Identifier
1346778685
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP134194 Issued in TX
Practice address
705 E Marshall Ave Ste 5000
Longview, TX 75601-5660
Phone
(903) 316-3646
NPI assigned
May 31, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP134194 TX Primary

Addresses

Primary practice location

705 E Marshall Ave Ste 5000
Longview, TX 75601-5660

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400

Other identifiers 4

IdentifierTypeStateIssuer
P02270110OtherTXMEDICARE RAIL ROAD
817780OtherTXMEDICARE
8LE707OtherTXBCBS
380278704MedicaidTX

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
I20180117000463 TX Practitioner - Nurse Practitioner 2961761101 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Texas Tech University Health Science Center School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

800 E Dawson St
Christus Trinity Clinic
Tyler, TX 75701-2036
Phone (903) 510-1186

Hospital & facility affiliations

  • Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP134194TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Primary Care Physicians Southwest, PA Family CurrentSince Oct 1, 2017 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2019 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2019 Accepting new patients
Diagnostic Clinic of Longview PA PastSince Feb 1, 2019 Accepting new patients

Locations

323 E Hawkins Pkwy
Ste A
Longview, TX 75605
Phone (903) 758-2746

705 E Marshall Ave
Ste 5000
Longview, TX 75601
Phone (903) 315-1970

3133 Good Shepherd Way
Longview, TX 75605
Phone (903) 315-4422

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

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

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

Interoperability endpoints

  • Direct secure messaging: kurbanek197910@christushealth.direct-ci.net
  • FHIR API: https://api.platform.athenahealth.com/23550/brand/1/csg/1/fhir/r4

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1346778685",
    "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": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E MARSHALL AVE STE 5000",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015660",
            "telephone_number": "903-316-3646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "URBANEK",
        "first_name": "KYLE",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-31",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP134194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P02270110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "817780",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8LE707",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380278704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.