NPIMap

Individual provider Active NPI

Timothy D. Maynard, M.D.

  • Family Medicine Physician
  • Gatesville, TX
National Provider Identifier
1396706388
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
F6918 Issued in TX
Practice address
1507 W Main St
Gatesville, TX 76528-1024
Phone
(254) 865-2166
Fax
(254) 248-6306
NPI assigned
Mar 29, 2006
Last updated
Aug 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X F6918 TX Primary

Addresses

Primary practice location

1507 W Main St
Gatesville, TX 76528-1024

Mailing address

1507 W Main St
Gatesville, TX 76528-1024
Phone (254) 865-2166

Other identifiers 3

IdentifierTypeStateIssuer
1185183-01MedicaidTX
080161587OtherTXRR/MEDICARE
84802KOtherTXBLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmaynard@ch.cernerdirect.com Direct

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
I20100330000681 TX Practitioner - Family Practice 3870658909 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Coryell County Memorial Hospital Authority CurrentSince Dec 16, 2013 Accepting new patients
Coryell County Memorial Hospital Authority CurrentSince Dec 16, 2013 Accepting new patients
Coryell County Memorial Hospital Authority Current Accepting new patients

Locations

1507 W Main St
Gatesville, TX 76528
Phone (254) 865-8251

Interoperability endpoints

  • Direct secure messaging: tmaynard@ch.cernerdirect.com

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Coryell Memorial HospitalGatesville, TX, CCN 451379 Hospital Corporate Director Aug 1, 2013
Coryell HealthGatesville, TX, CCN 45Z379 Hospital Corporate Director Aug 1, 2013
Coryell Health Medical Clinic MoodyMoody, TX, CCN 678556 Rural health clinic Corporate Director Dec 6, 2013

Owned or controlled facilities with NPI records 3

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

Organizations & group practices 3

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1396706388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 W MAIN ST",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "765281024",
            "telephone_number": "254-865-2166",
            "fax_number": "254-248-6306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 W MAIN ST",
            "city": "GATESVILLE",
            "state": "TX",
            "postal_code": "765281024",
            "telephone_number": "254-865-2166",
            "fax_number": "254-248-6306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "TIMOTHY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "F6918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1185183-01",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/MEDICARE",
            "identifier": "080161587",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "84802K",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmaynard@ch.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Coryell Health Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1507 W Main St",
            "city": "Gatesville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765281024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gatesville, TX

Sources for this page

Verify at the official NPI Registry.