Active NPI
Mark Douglas Miller, MD
- Family Medicine Physician
- Kilgore, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- J3705
- Practice address
- 1718 S Henderson Blvd
Kilgore, TX 75662-3553 - Phone
- (903) 983-2110
- NPI assigned
- Feb 17, 2006
- Sex
- Male
- Sole proprietor
- No
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 | J3705 | TX | Primary |
Addresses
Primary practice location
1718 S Henderson Blvd
Kilgore, TX 75662-3553
Mailing address
PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6450
Other practice location 1
705 E Marshall Ave Ste 1002
Longview, TX 75601-5660
Phone (903) 759-7200
Other practice location 2
701 E Marshall Ave Ste 400
Longview, TX 75601-5595
Phone (903) 315-5600
Other practice location 3
1614 S Henderson Blvd Ste A
Kilgore, TX 75662-3518
Phone (903) 983-2110
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124882506 | Medicaid | TX | |
| 124882502 | Medicaid | TX |
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
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Texas Medical School at San Antonio, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
105 Zeid Blvd
Henderson, TX 75652-6070
Phone (903) 595-2283
1600 Broadway Ave
Gladewater, TX 75647-5040
Phone (903) 315-5630
1614 S Henderson Blvd
Suite a
Kilgore, TX 75662-3518
Phone (903) 983-2110
620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900
630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560
Hospital & facility affiliations
- Christus Good Shepherd Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trincare Inc | Current | Accepting new patients | |
| Mother Frances Hospital Jacksonville | Current | Accepting new patients | |
| Mother Frances Hospital Regional Health Care Center | Current | Accepting new patients | |
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| Christus Trinity Clinic Texas | Family Medicine | Current | Accepting new patients |
| East Texas Treatment Center | Past | Accepting new patients |
Locations
2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500
1614 S Henderson Blvd
Ste A
Kilgore, TX 75662
Phone (903) 983-2110
1718 S Henderson Blvd
Kilgore, TX 75662
Phone (903) 983-2110
3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000
705 E Marshall Ave
Ste 1002
Longview, TX 75601
Phone (903) 247-7700
630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888
800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018
Interoperability endpoints
- mmiller6827@christushealth.direct-ci.net
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Tyler, TX
- NPI 1285684225
-
- Critical Access Hospital
- Jacksonville, TX
- NPI 1952306672
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1679578439
-
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1801673165
-
- Clinical Medical Laboratory
- Tyler, TX
- NPI 1033351226
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Kilgore, TX
- NPI 1023002425
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Longview, TX
- NPI 1124092036
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1609840388",
"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": "903-324-6450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1718 S HENDERSON BLVD",
"city": "KILGORE",
"state": "TX",
"postal_code": "756623553",
"telephone_number": "903-983-2110"
}
],
"practiceLocations": [
{
"address_1": "705 E Marshall Ave Ste 1002",
"address_purpose": "LOCATION",
"city": "Longview",
"state": "TX",
"postal_code": "756015660",
"country_code": "US",
"telephone_number": "903-759-7200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "701 E Marshall Ave Ste 400",
"address_purpose": "LOCATION",
"city": "Longview",
"state": "TX",
"postal_code": "756015595",
"country_code": "US",
"telephone_number": "903-315-5600",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1614 S Henderson Blvd Ste A",
"address_purpose": "LOCATION",
"city": "Kilgore",
"state": "TX",
"postal_code": "756623518",
"country_code": "US",
"telephone_number": "903-983-2110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MILLER",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "J3705",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124882506",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124882502",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kilgore, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; 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.