Individual provider Active NPI

Judson Stewart Welch, P.A.

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1457545345
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA05293 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 593-8441
NPI assigned
Sep 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA05293 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 606-6400

Other practice location 1

8389 S Broadway Ave
Tyler, TX 75703-5408
Phone (903) 606-6500

Other practice location 2

2026 S Jackson St
Jacksonville, TX 75766-5822
Phone (903) 541-4500

Other practice location 3

115 Airport Rd
Sulphur Springs, TX 75482-2105
Phone (903) 885-7671

Other identifiers 21

IdentifierTypeStateIssuer
75-2616977-028OtherTXTRICARE
P00431993OtherTXRAILROAD MEDICARE
00T71UOtherTXBCBS
188998204MedicaidTX
188998205MedicaidTX
188998206MedicaidTX
8Y2728OtherTXBLUE CROSS
75-0818167-048OtherTXTRICARE
188998203MedicaidTX
75-2616977-001OtherTXTRICARE
75-0818167-015OtherTXTRICARE
75-2616977-002OtherTXTRICARE
P01069699OtherTXRAIL ROAD
75-0818167-022OtherTXTRICARE
75-0818167-044OtherTXTRICARE
75-1976930-015OtherTXTRICARE
874N75OtherTXBCBS
876N24OtherTXBCBS
8900NCOtherTXBCBS
P01276459OtherTXRAIL ROAD
P01304491OtherTXRAIL ROAD

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
I20071121000343 TX Practitioner - Physician Assistant 7618065855 Reassigns benefits to 6 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA05293TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 28, 2013 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince May 7, 2012 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 28, 2013 Accepting new patients
Longview Emergency Medicine Associates PLLC Physician Assistant Past Accepting new patients

Locations

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

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

323 E Hawkins Pkwy
Longview, TX 75605
Phone (903) 315-2000

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

811 S Washington Ave
Marshall, TX 75670
Phone (903) 315-1488

115 Airport Rd
Sulphur Springs, TX 75482
Phone (903) 439-4052

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

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

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

8389 S Broadway Ave
Tyler, TX 75703
Phone (903) 606-4129

Interoperability endpoints

  • Direct secure messaging: jwelch7998@christushealth.direct-ci.net

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1457545345",
    "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": "903-606-6400",
            "fax_number": "903-606-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-593-8441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8389 S Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757035408",
            "country_code": "US",
            "telephone_number": "903-606-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2026 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757665822",
            "country_code": "US",
            "telephone_number": "903-541-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Airport Rd",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754822105",
            "country_code": "US",
            "telephone_number": "903-885-7671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELCH",
        "first_name": "JUDSON",
        "middle_name": "STEWART",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-028",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00431993",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00T71U",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188998204",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188998205",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188998206",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8Y2728",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-048",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188998203",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-015",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P01069699",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-022",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-044",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-1976930-015",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "874N75",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "876N24",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8900NC",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P01276459",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "P01304491",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.