Individual provider Active NPI

Michael Y Ashigbi, M.D.

  • Hematology & Oncology Physician
  • Tyler, TX
National Provider Identifier
1649275355
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
J7415 Issued in TX
Practice address
721 Clinic Dr
Ste a
Tyler, TX 75701-2043
Phone
(903) 592-6152
Fax
(903) 526-0629
NPI assigned
Jun 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X J7415 TX Primary

Addresses

Primary practice location

721 Clinic Dr
Ste a
Tyler, TX 75701-2043

Mailing address

721 Clinic Dr
Ste a
Tyler, TX 75701-2043
Phone (903) 592-6152

Other identifiers 2

IdentifierTypeStateIssuer
81690XOtherTXBLUE CROSS BLUE SHIELD
1027716-01MedicaidTX

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
I20050113000132 TX Practitioner - Hematology/OncologyPractitioner - Internal MedicinePractitioner - HematologyPractitioner - Medical Oncology 3375592744 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J7415TXMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Aug 1, 2019 Accepting new patients
University of Texas Health Science Center at Tyler-Facility-Physician CurrentSince Aug 1, 2019 Accepting new patients

Locations

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

721 Clinic Dr
#A
Tyler, TX 75701
Phone (903) 592-6152

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.

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1649275355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 CLINIC DR",
            "address_2": "STE A",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012043",
            "telephone_number": "903-592-6152",
            "fax_number": "903-526-0629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 CLINIC DR",
            "address_2": "STE A",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012043",
            "telephone_number": "903-592-6152",
            "fax_number": "903-526-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASHIGBI",
        "first_name": "MICHAEL",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "J7415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "81690X",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027716-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.