Individual provider Active NPI

Andrew L Hamby, MD

  • Pediatrics Physician
  • Tyler, TX
National Provider Identifier
1760412209
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
V0415 Issued in TX
Practice address
706 Turtle Creek Dr
Tyler, TX 75701-1833
Phone
(903) 595-3942
NPI assigned
Jul 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-9583 AR
Pediatrics Physician 208000000X 2003020131 MO
Pediatrics Physician 208000000X V0415 TX Primary

Addresses

Primary practice location

706 Turtle Creek Dr
Tyler, TX 75701-1833

Mailing address

#1 Children'S Way, Slot 844
Acmg
Little Rock, AR 72202-3500
Phone (501) 364-2090

Other practice location 1

2601 Gene George Blvd
Springdale, AR 72762-0845
Phone (479) 725-6880

Other identifiers 5

IdentifierTypeStateIssuer
181341OtherMOANTHEM
215364001MedicaidAR
200014340AMedicaidOK
100643070AMedicaidKS
209083005MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160503001356 AR Practitioner - Pediatric Medicine 5395044960 Reassigns benefits to 1 organization
I20240603002835 TX Practitioner - Pediatric Medicine 5395044960 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2003020131MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Benton County Physician Services LLC CurrentSince Apr 1, 2016 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 26, 2024 Accepting new patients
Christus Trinity Clinic Texas Pediatrics CurrentSince Jul 26, 2024 Accepting new patients
Trinity Clinic Past Accepting new patients

Locations

101 Sun Meadow Dr
Centerton, AR 72719
Phone (479) 273-1426

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

706 Turtle Creek Dr
Tyler, TX 75701
Phone (903) 593-1786

Organizations & group practices 4

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1760412209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#1 CHILDREN'S WAY, SLOT 844",
            "address_2": "ACMG",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-2090",
            "fax_number": "501-364-3929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 TURTLE CREEK DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011833",
            "telephone_number": "903-595-3942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 Gene George Blvd",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727620845",
            "country_code": "US",
            "telephone_number": "479-725-6880",
            "fax_number": "479-725-6582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAMBY",
        "first_name": "ANDREW",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-9583",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2003020131",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V0415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "181341",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215364001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200014340A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100643070A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209083005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.