Individual provider Active NPI

Robert Stanley Taylor III, MD

  • MOHS-Micrographic Surgery Physician
  • Longview, TX
National Provider Identifier
1760441893
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
H0877 Issued in TX
Practice address
3535 N Fourth St Ste 400
Longview, TX 75605-0036
Phone
(903) 757-3881
Fax
(903) 757-5948
NPI assigned
Mar 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X H0877 TX Primary

Addresses

Primary practice location

3535 N Fourth St Ste 400
Longview, TX 75605-0036

Mailing address

3535 N Fourth St Ste 400
Longview, TX 75605-0036
Phone (903) 757-3881

Other identifiers 1

IdentifierTypeStateIssuer
119053001MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwallis1@directaddress.com Direct

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
I20100525000752 TX Practitioner - Dermatology 2163551466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Medical Branch at Galveston, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wallis Dermatology Associates PLLCGroup PAC ID 0749440188, 11 clinicians

Practice addresses (Care Compare)

3535 N 4TH St
Suite 400
Longview, TX 75605-0036
Phone (903) 757-3881

Merit-based Incentive Payment System (MIPS)

Final score
74.54 of 100Reported as group
Quality
68.5
Promoting interoperability
92
Improvement activities
40
Cost
53.31

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision64
Removal of skin lesions1-10
Removal of skin cancer95
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H0877TXMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wallis Dermatology Associates PLLC CurrentSince Sep 1, 2018 Accepting new patients

Locations

3535 N Fourth St
Ste 400
Longview, TX 75605
Phone (903) 757-3881

6 Doctor Cir
Longview, TX 75605
Phone (903) 592-1664

1900 S Washington Ave
Ste E
Marshall, TX 75670
Phone (903) 503-7330

Organizations & group practices 1

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": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1760441893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 400",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050036",
            "telephone_number": "903-757-3881",
            "fax_number": "903-757-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 400",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050036",
            "telephone_number": "903-757-3881",
            "fax_number": "903-757-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "ROBERT",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "H0877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119053001",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwallis1@directaddress.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "LONGVIEW",
            "address_1": "3535 N Fourth St Ste 400",
            "city": "Longview",
            "state": "TX",
            "country_code": "US",
            "postal_code": "756050036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.