NPIMap

Individual provider Active NPI

Luis A Destarac, M.D.

  • Pulmonary Disease Physician
  • Tyler, TX
National Provider Identifier
1477513927
Registry record updated Nov 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
K0712 Issued in TX
Practice address
912 S Fleishel Ave
Tyler, TX 75701-2018
Phone
(903) 592-6901
Fax
(903) 595-2571
NPI assigned
Mar 27, 2006
Last updated
Nov 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X K0712 TX
Allergy Physician 207KA0200X K0712 TX
Critical Care Medicine (Internal Medicine) Physician 207RC0200X K0712 TX
Pulmonary Disease Physician 207RP1001X K0712 TX Primary

Addresses

Primary practice location

912 S Fleishel Ave
Tyler, TX 75701-2018

Mailing address

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

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
I20041023000284 TX Practitioner - Pulmonary Disease 3375504251 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 1991
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)

912 S Fleishel Ave
Tyler, TX 75701-2018
Phone (903) 592-6901

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K0712TXMDCritical Care Medicine (Internal Medicine) Physician
34103TNMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince Jun 1, 2023 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
Etmc Physician Group Inc. CurrentSince May 1, 2019 Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Jun 1, 2023 Accepting new patients
Starks Medical Past Accepting new patients
Sterling Emergency Services of the Midwest, Inc Past Accepting new patients

Locations

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

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

912 S Fleishel Ave
Tyler, TX 75701
Phone 90359269011811

Interoperability endpoints

  • Direct secure messaging: ldestarac@psotmd.gwaydirect.com
  • Direct secure messaging: ldestarac355004@ahs.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1477513927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-595-2571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012018",
            "telephone_number": "903-592-6901",
            "fax_number": "903-595-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTARAC",
        "first_name": "LUIS",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "TX",
            "license": "K0712",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "TX",
            "license": "K0712",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "K0712",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "K0712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.