Individual provider Active NPI

Mark Douglas Miller, MD

  • Family Medicine Physician
  • Kilgore, TX
National Provider Identifier
1609840388
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J3705 Issued in TX
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

Updated by the provider on Jun 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
124882506MedicaidTX
124882502MedicaidTX

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071108000659 TX Practitioner - Family Practice 3779671722 Reassigns benefits to 3 organizations

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
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

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 Hospital, Longview, TX, CCN 450032

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Trincare Inc Current Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 26, 2006 Accepting new patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Aug 26, 2006 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

  • Direct secure messaging: 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.

Hospital & facility affiliations 1

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": "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

Verify at the official NPI Registry.