Individual provider Active NPI

Ellen Stockton Walraven, M.D.

  • Internal Medicine Physician
  • Tyler, TX
National Provider Identifier
1356398457
Registry record updated May 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H7843 Issued in TX
Practice address
520 Douglas Blvd
Tyler, TX 75702-8307
Phone
(903) 593-1721
NPI assigned
May 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H7843 TX Primary

Addresses

Primary practice location

520 Douglas Blvd
Tyler, TX 75702-8307

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
8GQ837OtherTXBCBS
75-2616977-007OtherTXTRICARE
099129105MedicaidTX

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041122000531 TX Practitioner - Internal MedicinePractitioner - Infectious Disease 9335104181 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Baylor College of Medicine, 1983
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)

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 593-1721

Hospital & facility affiliations

  • Christus Homecare Home health agency, Tyler, TX, CCN 743197
  • Enhabit Home Health Home health agency, Tyler, TX, CCN 459457
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032
  • Christus Mother Frances Hospital Sulphur Springs Hospital, Sulphur Springs, TX, CCN 450236

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince May 1, 2016 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas CurrentSince May 1, 2017 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas Internal Medicine CurrentSince May 1, 2017 Accepting new patients

Locations

1500 S Main St
Ft Worth, TX 76104
Phone (817) 921-3431

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

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

1301 Wonder World Dr
San Marcos, TX 78666
Phone (512) 353-8979

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

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

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

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Interoperability endpoints

  • Direct secure messaging: ewalraven140048@christushealth.direct-ci.net

Organizations & group practices 5

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 5

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": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1356398457",
    "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": "520 DOUGLAS BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028307",
            "telephone_number": "903-593-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALRAVEN",
        "first_name": "ELLEN",
        "middle_name": "STOCKTON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-27",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H7843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8GQ837",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-007",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099129105",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.