Courtney Brooks Chism, DO
Individual provider Active NPI Family Medicine Physician · Longview, TX
NPI 1821551235 · NPPES record last updated Nov 4, 2024
Key facts
- NPI
- 1821551235
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- T8783 (TX)
- Practice address
- 705 E Marshall Ave Ste 1002
Longview, TX 75601-5660 - Phone
- (903) 759-7200
- NPI assigned
- Apr 11, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Christus Trinity Clinic Texas
Practice addresses (Care Compare)
2101 W Loop
Longview, TX 75604-2506
323 E Hawkins Pkwy
Longview, TX 75605-8153
620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900
630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560
PO Box
Suite 846098
Dallas, TX 75284-6098
Hospital & facility affiliations
- Christus Good Shepherd
- Christus Good Shepherd Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220915003389 | TX | Practitioner - Family Practice | 0749513067 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Current |
Accepting new patients | |
| Christus Trinity Clinic Texas | Family Medicine | Current |
Accepting new patients |
Locations
1600 Broadway Ave
Gladewater, TX 75647
Phone (903) 315-5630
705 E Marshall Ave
Ste 1002
Longview, TX 75601
Phone (903) 247-7700
2101 W Loop 281
Longview, TX 75604
Phone (903) 315-4180
323 E Hawkins Pkwy
Ste A
Longview, TX 75605
Phone (903) 758-2746
630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888
Interoperability endpoints
- cchism289601@christushealth.direct-ci.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | T8783 | TX | Yes |
Addresses
Primary practice location
705 E Marshall Ave Ste 1002
Longview, TX 75601-5660
Mailing address
23139 N Waterlake Dr
Richmond, TX 77406-9614
Phone (281) 660-3276
Other practice location 1
2101 W Loop 281
Longview, TX 75604-2506
Phone (903) 315-4180
Other practice location 2
1600 Broadway Ave
Gladewater, TX 75647-5040
Phone (903) 315-5630
Other practice location 3
323 E Hawkins Pkwy Ste A
Longview, TX 75605-8162
Phone (903) 247-3400
Other providers in Longview, TX
- Childress Vision Clinic
- Alicia Childress
- Carl W Childress
- Laura Childress
- Madhu Chiluveri
- Jennifer L. Chow
- Thomas Chow
- Beverly Blaine Christiansen
- Beverly H. Christopher
- Christus Good Shepherd Medical Center
All providers in Longview, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.