NPIMap

Organization Active NPI

Christus Health Ark-la-Tex

  • Hematology & Oncology Physician
  • Texarkana, TX
National Provider Identifier
1790162238
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
CHRISTUS HEALTH ARK-LA-TEX
Practice address
2602 Saint Michael Dr Ste 202
Texarkana, TX 75503-5221
Phone
(903) 614-5480
Fax
(903) 614-5483
NPI assigned
May 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Authorized official

Name
Jason Matthew Adams
Title
President
Phone
(702) 738-4546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

2602 Saint Michael Dr Ste 202
Texarkana, TX 75503-5221

Mailing address

PO Box 3070
Texarkana, TX 75504-3070
Phone (903) 614-2943

Other names 1

  • CHRISTUS St Michael Oncology Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050324001186 TX Part B Supplier - Clinic/Group Practice 2264325588 Receives reassigned benefits from 74 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Texarkana, TX

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Christus Health Ark-la-Tex7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1790162238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3070",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755043070",
            "telephone_number": "903-614-2943",
            "fax_number": "903-614-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 SAINT MICHAEL DR STE 202",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755035221",
            "telephone_number": "903-614-5480",
            "fax_number": "903-614-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH ARK-LA-TEX",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-738-4546"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS St Michael Oncology Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CHRISTUS St Michael Oncology Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.