Individual provider Active NPI

Micah Gibson, M.D.

  • Otolaryngology Physician
  • Beaumont, TX
National Provider Identifier
1760915490
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
T8542 Issued in TX
Practice address
740 Hospital Dr Ste 300
Beaumont, TX 77701-4666
Phone
(409) 212-8111
Fax
(409) 981-1787
NPI assigned
Apr 10, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Otolaryngology Physician 207Y00000X T8542 TX Primary

Addresses

Primary practice location

740 Hospital Dr Ste 300
Beaumont, TX 77701-4666

Mailing address

740 Hospital Dr Ste 300
Beaumont, TX 77701-4666
Phone (409) 212-8111

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
I20220729002013 TX Practitioner - Otolaryngology 6507248069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Emory University School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southeast Texas Ear, Nose and Throat, LLPGroup PAC ID 8426063736, 14 clinicians

Practice addresses (Care Compare)

740 Hospital Dr
Suite 300
Beaumont, TX 77701-4664

740 Hospital Dr
Suite 300
Beaumont, TX 77701-4666
Phone (409) 212-8111

Hospital & facility affiliations

  • Baptist Beaumont Hospital Hospital, Beaumont, TX, CCN 450346
  • Christus Southeast Texas- St Elizabeth Hospital, Beaumont, TX, CCN 450034

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Texas Ear, Nose & Throat, LLP Otolaryngology CurrentSince Aug 1, 2022 Accepting new patients

Locations

740 Hospital Dr
Ste 300
Beaumont, TX 77701
Phone (409) 212-8111

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.

Hospital & facility affiliations 2

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": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1760915490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 HOSPITAL DR STE 300",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014666",
            "telephone_number": "409-212-8111",
            "fax_number": "409-981-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HOSPITAL DR STE 300",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014666",
            "telephone_number": "409-212-8111",
            "fax_number": "409-981-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MICAH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "T8542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.