Active NPI
Stephen C Spain, MD
- Family Medicine Physician
- Tyler, TX
National Provider Identifier
1487686309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G0154
- Practice address
- 5040 Kinsey Dr
Suite 300
Tyler, TX 75703-3005 - Phone
- (903) 561-8300
- Fax
- (903) 561-8327
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G0154 | TX | Primary |
Addresses
Primary practice location
5040 Kinsey Dr
Suite 300
Tyler, TX 75703-3005
Mailing address
5040 Kinsey Dr
Suite 300
Tyler, TX 75703-3005
Phone (903) 561-8300
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 133341103 | Medicaid | TX | |
| 010054743 | Other | TX | RAILROAD MEDICARE |
| 89X859 | Other | TX | BLUE CROSS |
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080131000734 | TX | Practitioner - Family Practice | 8921180787 |
Receives reassigned benefits from 1 practitioner Practice locations: Tyler, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Texas Medical School at Houston, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
5040 Kinsey Dr
Tyler, TX 75703-3046
Phone (903) 561-8300
Hospital & facility affiliations
- Paradigm Homecare
- Christus Homecare
- Christus Mother Frances Hospital
- Ut Health East Texas Tyler Regional Hospital
- Baylor Scott & White Texas Spine & Joint Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 30 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G0154 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tyler Wellness Clinic | Current | Accepting new patients | |
| Stephen C Spain | Family Medicine | Current | Accepting new patients |
Locations
5040 Kinsey Dr
Ste 300
Tyler, TX 75703
Phone (903) 561-8300
Interoperability endpoints
- stephen.spain.p1@direct.sspainmd.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
Organizations & group practices 2
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.
-
- Primary Care Clinic/Center
- Tyler, TX
- NPI 1508572959
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Tyler, TX
- NPI 1669994471
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1679578439
Hospital
-
- Home Health Agency
- Tyler, TX
- NPI 1376540047
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258675200000",
"number": "1487686309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5040 KINSEY DR",
"address_2": "SUITE 300",
"city": "TYLER",
"state": "TX",
"postal_code": "757033005",
"telephone_number": "903-561-8300",
"fax_number": "903-561-8327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5040 KINSEY DR",
"address_2": "SUITE 300",
"city": "TYLER",
"state": "TX",
"postal_code": "757033005",
"telephone_number": "903-561-8300",
"fax_number": "903-561-8327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPAIN",
"first_name": "STEPHEN",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2009-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "G0154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "133341103",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "010054743",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "89X859",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}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 Nov 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.