NPIMap

Individual provider Active NPI

Susan C McMullen, M.D.

  • Family Medicine Physician
  • Gun Barrel City, TX
National Provider Identifier
1699758136
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25065 Issued in AZ
Practice address
100 Municipal Dr
Suite 300
Gun Barrel City, TX 75156-3702
Phone
(903) 713-1571
NPI assigned
Nov 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25065 AZ Primary

Addresses

Primary practice location

100 Municipal Dr
Suite 300
Gun Barrel City, TX 75156-3702

Mailing address

904 S Beckham Ave
Tyler, TX 75701-1906
Phone (903) 596-3588

Other identifiers 4

IdentifierTypeStateIssuer
102533MedicaidAZ
200017697OtherAZRR MEDICARE
86080015085308A020OtherAZTRIWEST
86080015085259B098OtherAZTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080325000061 TX Practitioner - Family Practice 8921197286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

100 Municipal Dr
Gun Barrel City, TX 75156-3703
Phone (903) 713-1574

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

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

701 Olympic Plaza Cir
Tyler, TX 75701-1950
Phone (903) 531-8109

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25065AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Starks Medical Past Accepting new patients

Locations

340 Seven Springs Way
Ste 100
Brentwood, TN 37027
Phone (615) 296-3000

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

100 Municipal Dr
Ste 300
Gun Barrel City, TX 75156
Phone (903) 713-1500

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Interoperability endpoints

  • Direct secure messaging: smcmullen355528@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 9

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208390400000",
    "number": "1699758136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011906",
            "telephone_number": "903-596-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MUNICIPAL DR",
            "address_2": "SUITE 300",
            "city": "GUN BARREL CITY",
            "state": "TX",
            "postal_code": "751563702",
            "telephone_number": "903-713-1571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMULLEN",
        "first_name": "SUSAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-29",
        "last_updated": "2008-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "25065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102533",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "200017697",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085308A020",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "86080015085259B098",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gun Barrel City, TX

Sources for this page

Verify at the official NPI Registry.