Individual provider Active NPI

Stefanie M Diaz, M.D.

  • Nephrology Physician
  • Tyler, TX
National Provider Identifier
1689723637
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
K8739 Issued in TX
Practice address
1133 Medical Dr
Tyler, TX 75701-2130
Phone
(903) 595-5486
Fax
(903) 595-5128
NPI assigned
Jan 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X K8739 TX Primary

Addresses

Primary practice location

1133 Medical Dr
Tyler, TX 75701-2130

Mailing address

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

Other identifiers 3

IdentifierTypeStateIssuer
200214910 AMedicaidOK
040253901MedicaidTX
390006572OtherRAILROAD MEDICARE

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
I20100108000832 TX Practitioner - NephrologyPractitioner - Internal Medicine 0547322638 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tyler Nephrology Associates PAGroup PAC ID 6901862242, 27 clinicians
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

1133 Medical Dr
Tyler, TX 75701-2130
Phone (903) 595-5486

18118 FM 344
Flint, TX 75762-6010
Phone (903) 825-3292

2000 S Palestine St
Athens, TX 75751-5610
Phone (903) 676-1000

2701 US Hwy 271 N
Pittsburg, TX 75686-4289
Phone (903) 946-5442

300 Wilson St
Henderson, TX 75652-5956
Phone (903) 655-6536

409 Cottage Rd
Carthage, TX 75633-1466
Phone (903) 694-4790

501 S Ragsdale St
Jacksonville, TX 75766-2434
Phone (903) 541-5143

Hospital & facility affiliations

  • Renal Care Group Sulphur Springs Dialysis facility, Sulphur Springs, TX, CCN 672544
  • Fresenius Medical Care Tyler Home Dialysis Dialysis facility, Tyler, TX, CCN 452882
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • Ut Health East Texas Athens Hospital Hospital, Athens, TX, CCN 450389
  • Christus Mother Frances Hospital Sulphur Springs Hospital, Sulphur Springs, TX, CCN 450236
  • Ut Health East Texas Jacksonville Hospital Hospital, Jacksonville, TX, CCN 450194
  • Christus Trinity Mother Frances Rehab, a Partner O Inpatient rehabilitation facility, Tyler, TX, CCN 453056

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K8739TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Nephrology Associates, P.a. Nephrology CurrentSince Oct 15, 1999 Accepting new patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2022 Accepting new patients
Etmc Physician Group Inc. CurrentSince Nov 1, 2022 Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

1133 Medical Dr
Tyler, TX 75701
Phone 9035955486173

Interoperability endpoints

  • Direct secure messaging: sdiaz32232@direct.acumenmd.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: sdiaz355444@ahs.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681948800000",
    "number": "1689723637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 MEDICAL DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012130",
            "telephone_number": "903-595-5486",
            "fax_number": "903-595-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "STEFANIE",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "K8739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200214910 A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040253901",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "390006572",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.