NPIMap

Organization Active NPI

East Texas Physician Assistant Services

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1407273428
Registry record updated Mar 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04135 Issued in TX
Legal business name
EAST TEXAS PHYSICIAN ASSISTANT SERVICES
Practice address
5380 Old Bullard Rd Ste 600-125
Tyler, TX 75703-3607
Phone
(903) 504-5353
NPI assigned
Mar 27, 2014
Last updated
Mar 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2014

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

Authorized official

Name
Mr. Jason David Layne, PA-CNPI 1578555355
Title
Physician Assistant
Phone
(903) 504-5353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04135 TX Primary

Addresses

Primary practice location

5380 Old Bullard Rd Ste 600-125
Tyler, TX 75703-3607

Mailing address

5380 Old Bullard Rd Ste 600-125
Tyler, TX 75703-3607
Phone (903) 504-5353

Other names 1

  • ETPAS Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140805000371 TX Part B Supplier - Clinic/Group Practice 9032336706 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

5380 Old Bullard Rd
#600125
Tyler, TX 75703
Phone (903) 504-5353

5380 Old Bullard Rd
Ste 600125
Tyler, TX 75703
Phone (903) 504-5353

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1407273428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5380 OLD BULLARD RD STE 600-125",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033607",
            "telephone_number": "903-504-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5380 OLD BULLARD RD STE 600-125",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033607",
            "telephone_number": "903-504-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PHYSICIAN ASSISTANT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "LAYNE",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "903-504-5353",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETPAS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.