NPIMap

Individual provider Active NPI

Gary M Waddell, M.D.

  • Diagnostic Radiology Physician
  • Palestine, TX
National Provider Identifier
1629029806
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
K1716 Issued in TX
Practice address
2900 S Loop 256
Palestine, TX 75801-6958
Phone
(903) 731-1084
NPI assigned
May 13, 2006
Last updated
Jun 8, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X K1716 TX Primary

Addresses

Primary practice location

2900 S Loop 256
Palestine, TX 75801-6958

Mailing address

4777 US Highway 259
Longview, TX 75605-7668
Phone (903) 663-4800

Other identifiers 1

IdentifierTypeStateIssuer
102048902MedicaidTX

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
I20040802001459 TX Practitioner - Diagnostic Radiology 9638140817 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical Branch at Galveston, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eagle Partners, PLLCGroup PAC ID 9032205752, 170 clinicians
Singleton Associates PAGroup PAC ID 6305731118, 814 clinicians

Practice addresses (Care Compare)

1922 Cresson Dr
Southlake, TX 76092-9202
Phone 28187045922120

2201 W Lampasas St
Ennis, TX 75119-5644
Phone (713) 461-3573

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K1716TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Star CN, LP CurrentSince Jul 1, 2023 Accepting new patients
Gateway Diagnostic Imaging LLC CurrentSince Jun 8, 2020 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Feb 1, 2018 Accepting new patients
Eagle Partners, PLLC Diagnostic Radiology CurrentSince Mar 1, 2018 Accepting new patients
Gateway Diagnostic Imaging Sherman, LLC CurrentSince Jun 8, 2023 Accepting new patients
Medical Imaging Consultants LLP Diagnostic Radiology Past Accepting new patients

Locations

13301 N Meridian Ave
Ste 600A
Oklahoma City, OK 73120
Phone (405) 752-1994

9901 S Pennsylvania Ave
Oklahoma City, OK 73159
Phone (405) 691-8558

712 N Washington Ave
Ste 102
Dallas, TX 75246
Phone (214) 515-0016

9440 Poppy Dr
Dallas, TX 75218
Phone (214) 324-6100

2201 W Lampasas St
Ennis, TX 75119
Phone (469) 256-2458

1110 N Sarah Dewitt Dr
Gonzales, TX 78629
Phone (830) 672-3845

6720 Bertner Ave
#2270
Houston, TX 77030
Phone (832) 355-4092

6720 Bertner Ave
#270
Houston, TX 77030
Phone (832) 355-4092

1845 Precinct Line Rd
Ste 209
Hurst, TX 76054
Phone (817) 336-4638

9155 Grapevine Hwy
Ste 120
North Richland Hills, TX 76180

2900 S Loop 256
Palestine, TX 75801
Phone (903) 731-1021

2555 Jimmy Johnson Blvd
Port Arthur, TX 77640
Phone (409) 724-7389

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": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339113600000",
    "number": "1629029806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 US HIGHWAY 259",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756057668",
            "telephone_number": "903-663-4800",
            "fax_number": "903-663-0378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758016958",
            "telephone_number": "903-731-1084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2012-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "K1716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102048902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

Verify at the official NPI Registry.