Active NPI
Max T Tijerino, PA-C
- Physician Assistant
- Tyler, TX
National Provider Identifier
1649721366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10936
- Practice address
- 703 S Fleishel Ave
Ste 5000
Tyler, TX 75701-2015 - Phone
- (903) 525-2992
- Fax
- (903) 525-2685
- NPI assigned
- Oct 18, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | AL | ||
| Physician Assistant | 363A00000X | PA10936 | TX | Primary |
Addresses
Primary practice location
703 S Fleishel Ave
Ste 5000
Tyler, TX 75701-2015
Mailing address
PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 75-2616977-039 | Other | TX | TRICARE |
| 75-2616977-123 | Other | TX | TRICARE |
| 88117MA | Other | TX | BCBS |
| 365425301 | Medicaid | TX | |
| P01762498 | Other | TX | RAIL ROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10936 | TX | MD | Physician Assistant |
Interoperability endpoints
- mtijerino136610@christushealth.direct-ci.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486684800000",
"number": "1649721366",
"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": "703 S FLEISHEL AVE",
"address_2": "STE 5000",
"city": "TYLER",
"state": "TX",
"postal_code": "757012015",
"telephone_number": "903-525-2992",
"fax_number": "903-525-2685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIJERINO",
"first_name": "MAX",
"middle_name": "T",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-18",
"last_updated": "2017-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "AL",
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA10936",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-2616977-039",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-2616977-123",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "88117MA",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "365425301",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "P01762498",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.