Prosthetic-Orthotic Associates of East Texas, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

000086 Issued in TX

Legal business name

PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.

Practice address

1028 E Idel St
Tyler, TX 75701-2024

Phone

(903) 592-6574

Fax

(903) 595-3862

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Bruce P. McClellan, CPONPI 1104976182

Title

President/Owner

Phone

(903) 592-6574

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Prosthetic-Orthotic Associates of East Texas, Inc.

  • Prosthetic/Orthotic Supplier
  • Longview, TX
  • NPI 1083592364

  3678691219

  Same PAC ID

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

Medicare medical equipment & supply locations

Tax ID family

Prosthetic-Orthotic Associates of East Texas Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Prosthetic-Orthotic Associates of East Texas, Inc.

  • Prosthetic/Orthotic Supplier
  • Longview, TX
  • NPI 1083592364
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Prosthetic-Orthotic Associates of East Texas, Inc.

  • Prosthetic/Orthotic Supplier
  • Longview, TX
  • NPI 1083592364
  NPPES parent name

Practitioners 2

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.

• Bruce Patrick McClellan, C.P.O.

  • Orthotist
  • Tyler, TX
  • NPI 1104976182

  Prosthetist

  NPD (past) Authorized official
• Matthew Bruce McClellan, C.P.O.

  • Prosthetist
  • Tyler, TX
  • NPI 1073134177
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1780624148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 E IDEL ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012024",
            "telephone_number": "903-592-6574",
            "fax_number": "903-595-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 E IDEL ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012024",
            "telephone_number": "903-592-6574",
            "fax_number": "903-595-3862"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1122 E Front St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028414",
            "country_code": "US",
            "telephone_number": "903-592-6574",
            "fax_number": "903-595-3862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROSTHETIC-ORTHOTIC ASSOCIATES OF EAST TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "MCCLELLAN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "903-592-6574",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "000086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN-ORTHOTICS",
            "identifier": "079440601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CSHCN-PROTHETICS",
            "identifier": "079439801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-TEXAS",
            "identifier": "515809",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087369701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Project Empowering, Inc
• Charlie Wayne Propst, MD
• Sherrie Amanda Prosper, COTA
• James Carey Prosperie, RPH
• Matthew F Prosser, D.D.S.
• Julie Prothro, LPC-ASSCOCIATE
• Joseph Lynn Prud'Homme Sr., M.D.
• David Stephen Prudhome, CRNA
• Kelsey Pruett
• Alyssa Pruitt, M.A. CCC-SLP

• Prosthetic/Orthotic Supplier in Tyler, TX
• Providers in Tyler, TX by specialty
• Prosthetic/Orthotic Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; 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.