Active NPI
Clinton John Carter, M.D.
- Emergency Medicine Physician
- Tyler, TX
National Provider Identifier
1679678270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- M3958
- Practice address
- 800 E Dawson St
Tyler, TX 75701-2036 - Phone
- (903) 593-8441
- NPI assigned
- Sep 14, 2006
- Last updated
- Mar 31, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | M3958 | TX | Primary |
Addresses
Primary practice location
800 E Dawson St
Tyler, TX 75701-2036
Mailing address
PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 184728701 | Medicaid | TX | |
| 0076PA | Other | TX | BCBS |
| 75-0818167-022 | Other | TX | TRICARE |
| 75-0818167-048 | Other | TX | TRICARE |
| 750818167022 | Other | TX | TRICARE |
| 106454512 | Medicaid | TX | |
| 75-2616977-001 | Other | TX | TRICARE |
| 8X8162 | Other | TX | BCBS |
| 75-2616977-028 | Other | TX | TRICARE |
| 8EX119 | Other | TX | BCBS |
| 75-2616977-002 | Other | TX | TRICARE |
| P01490696 | Other | TX | RAIL ROAD |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3958 | TX | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sabine County Hospital District | Emergency Medicine | Past | Accepting new patients |
| Rusk Emergency Medicine Associates PA | Emergency Medicine | Past | Accepting new patients |
| Mother Frances Hospital Winnsboro | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Mother Frances Hospital Winnsboro Rural Health Clinic
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1922294867
-
- Emergency Medicine Physician
- Henderson, TX
- NPI 1891998126
-
dba Sabine County Hospital
- General Acute Care Hospital
- Hemphill, TX
- NPI 1508862921
Emergency Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459382400000",
"number": "1679678270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 841656",
"city": "DALLAS",
"state": "TX",
"postal_code": "752841656",
"telephone_number": "903-531-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E DAWSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757012036",
"telephone_number": "903-593-8441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARTER",
"first_name": "CLINTON",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2016-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "M3958",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "184728701",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0076PA",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-0818167-022",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-0818167-048",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "750818167022",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106454512",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-2616977-001",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8X8162",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-2616977-028",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8EX119",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-2616977-002",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD",
"identifier": "P01490696",
"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 Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.