Individual provider Active NPI

Troy Allen Callender, MD

  • Otolaryngology Physician
  • Tyler, TX
National Provider Identifier
1699764290
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
H7940 Issued in TX
Practice address
1136 E Grande Blvd
Tyler, TX 75703-3982
Phone
(903) 592-5601
Fax
(903) 595-3304
NPI assigned
Oct 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X H7940 TX Primary

Addresses

Primary practice location

1136 E Grande Blvd
Tyler, TX 75703-3982

Mailing address

1136 E Grande Blvd
Tyler, TX 75703-3982
Phone (903) 592-5601

Other identifiers 1

IdentifierTypeStateIssuer
118622301MedicaidTX

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
I20120130000404 TX Practitioner - Otolaryngology 3678506011 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H7940TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heaton Ear Nose and Throat Associates of East Texas P a Otolaryngology CurrentSince Feb 11, 1991 Accepting new patients
Tyler Radiology Associates PA Past Accepting new patients

Locations

3413 Golden Rd
Tyler, TX 75701
Phone (903) 592-3666

1136 E Grande Blvd
Tyler, TX 75703
Phone (903) 592-3666

Interoperability endpoints

  • Direct secure messaging: troy.callender@1213.chartlogic.direct-ci.com

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": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1699764290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLENDER",
        "first_name": "TROY",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "H7940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118622301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.