NPIMap

Organization Active NPI

Christus Good Shepherd Medical Center

  • Anesthesiology Physician
  • Marshall, TX
National Provider Identifier
1760908404
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CHRISTUS GOOD SHEPHERD MEDICAL CENTER
Practice address
811 S Washington Ave
Marshall, TX 75670-5336
Phone
(903) 927-6000
Fax
(903) 927-6101
NPI assigned
Aug 15, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Norman Todd Hancock
Title
President/Ceo
Phone
(903) 315-4129

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Neonatal Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LN0000X
Critical Care Neonatal Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LN0005X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

811 S Washington Ave
Marshall, TX 75670-5336

Mailing address

811 S Washington Ave
Marshall, TX 75670-5336
Phone (903) 927-6000

Other practice location 1

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000

Other practice location 2

703 E Marshall Ave Ste 2000
Longview, TX 75601-5500
Phone (903) 315-5300

Other practice location 3

1612 S Henderson Blvd
Kilgore, TX 75662-3518
Phone (903) 983-2492

Other practice location 4

323 E Hawkins Pkwy Ste D
Longview, TX 75605-8165
Phone (903) 544-6700

Other practice location 5

323 E Hawkins Pkwy Ste E
Longview, TX 75605-8166
Phone (903) 544-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040604000400 TX Part B Supplier - Clinic/Group Practice 3779565544 Receives reassigned benefits from 106 practitioners
4 other NPIs on this enrollment
Practice locations: Marshall, TX; Longview, TX; Kilgore, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2036393Christus Good Shepherd Medical Center-Kilgore1612 S Henderson, Kilgore, TX 75662AccreditationMar 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Harrison County Hospital Association6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Locations

620 S Grove St
Ste 104
Marshall, TX 75670

815 S Washington Ave
Marshall, TX 75670
Phone (903) 927-6680

Practitioners & affiliated clinicians

Practitioners 108

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 108

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1760908404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 S WASHINGTON AVE",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756705336",
            "telephone_number": "903-927-6000",
            "fax_number": "903-927-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S WASHINGTON AVE",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756705336",
            "telephone_number": "903-927-6000",
            "fax_number": "903-927-6101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 E Marshall Ave",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015580",
            "country_code": "US",
            "telephone_number": "903-315-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 E Marshall Ave Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015500",
            "country_code": "US",
            "telephone_number": "903-315-5300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1612 S Henderson Blvd",
            "address_purpose": "LOCATION",
            "city": "Kilgore",
            "state": "TX",
            "postal_code": "756623518",
            "country_code": "US",
            "telephone_number": "903-983-2492",
            "fax_number": "903-984-5367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "323 E Hawkins Pkwy Ste D",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756058165",
            "country_code": "US",
            "telephone_number": "903-544-6700",
            "fax_number": "903-544-6735",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "323 E Hawkins Pkwy Ste E",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756058166",
            "country_code": "US",
            "telephone_number": "903-544-6700",
            "fax_number": "903-544-6735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHRISTUS GOOD SHEPHERD MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "903-315-4129"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Neonatal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.