Individual provider Active NPI

Jeffrey Scott Davis, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Tyler, TX
National Provider Identifier
1417481664
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
T6545 Issued in TX
Practice address
700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955
Phone
(903) 596-3504
Fax
(903) 596-3604
NPI assigned
Apr 14, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 32933 OK
Student in an Organized Health Care Education/Training Program 390200000X
Pain Medicine (Anesthesiology) Physician 207LP2900X T6545 TX Primary

Addresses

Primary practice location

700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955

Mailing address

700 Olympic Plaza Cir Ste 850
Tyler, TX 75701-1955
Phone (903) 596-3504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210806000110 OK Practitioner - Anesthesiology 1355745704 Reassigns benefits to 1 organization
I20220627000196 TX Practitioner - AnesthesiologyPractitioner - Pain Management 1355745704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
University of Oklahoma College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 590-5611

117 N Winnsboro St
Quitman, TX 75783-2144
Phone (903) 763-6220

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

2000 S Palestine St
Athens, TX 75751-5610
Phone (903) 676-1000

700 Olympic Plaza Cir
Tyler, TX 75701-1952

700 Olympic Plaza Cir
Suite 850
Tyler, TX 75701-1955
Phone (903) 596-3504

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T6545TXMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Etmc Physician Group Inc. CurrentSince Jun 1, 2022 Accepting new patients
Ou Health Partners, Inc CurrentSince Jul 1, 2021 Accepting new patients
Etmc Physician Group Inc. CurrentSince Jun 1, 2022 Accepting new patients
Starks Medical Past Accepting new patients

Locations

920 Stanton L Young Blvd
Ste 1140
Oklahoma City, OK 73104

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

920 Stanton L Young Blvd
#1140
Oklahoma City, OK 73104
Phone (405) 271-4515

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

700 Olympic Plaza Cir
Ste 850
Tyler, TX 75701
Phone (903) 595-2441

1000 E 5th St
Ste 100
Tyler, TX 75701
Phone (903) 590-5000

Interoperability endpoints

  • Direct secure messaging: jdavis707222@ahs.direct-ci.com

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 7

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": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1417481664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 850",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011955",
            "telephone_number": "903-596-3504",
            "fax_number": "903-596-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 850",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011955",
            "telephone_number": "903-596-3504",
            "fax_number": "903-596-3604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-14",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "32933",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TX",
            "license": "T6545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.