Individual provider Active NPI

John O'Donnell, M.D.

  • Internal Medicine Physician
  • Palestine, TX
National Provider Identifier
1629071709
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E8773 Issued in TX
Practice address
3201 S Loop 256
Ste 170
Palestine, TX 75801-6901
Phone
(903) 723-8800
NPI assigned
May 23, 2005
Last updated
Sep 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E8773 TX Primary

Addresses

Primary practice location

3201 S Loop 256
Ste 170
Palestine, TX 75801-6901

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400

Other identifiers 2

IdentifierTypeStateIssuer
80X517OtherADDITIONAL MEDICARE
139433009MedicaidTX

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
I20070309000292 TX Practitioner - Internal MedicinePractitioner - General Practice 8426945759 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2017 Accepting new patients
Christus Trinity Clinic Texas Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2020 Accepting new patients
Mother Frances Hospital Jacksonville CurrentSince Mar 1, 2020 Accepting new patients

Locations

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

3201 S Loop 256
Ste 170
Palestine, TX 75801
Phone (903) 723-8800

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

3201 S Loop 256
Palestine, TX 75801
Phone (903) 723-0330

2900 S Loop 256
Ste 2
Palestine, TX 75801
Phone (903) 723-7577

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: jodonnell150351@christushealth.direct-ci.net
  • Direct secure messaging: johnodonnell@etpa.allscriptsdirect.net

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1629071709",
    "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": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 S LOOP 256",
            "address_2": "STE 170",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758016901",
            "telephone_number": "903-723-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "E8773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADDITIONAL MEDICARE",
            "identifier": "80X517",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139433009",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

Verify at the official NPI Registry.