NPIMap

Organization Active NPI

Christus Health Ark-la-Tex

Doing business as CHRISTUS St Michael Atlanta Wound Care Center

  • General Practice Physician
  • Atlanta, TX
National Provider Identifier
1871916650
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CHRISTUS HEALTH ARK-LA-TEX
Doing business as
CHRISTUS St Michael Atlanta Wound Care Center
Practice address
1007 S William St
Atlanta, TX 75551-3245
Phone
(903) 614-4200
Fax
(903) 614-4244
NPI assigned
Jan 29, 2014
Last updated
Oct 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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
(903) 614-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

1007 S William St
Atlanta, TX 75551-3245

Mailing address

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

Other names 1

  • CHRISTUS St Michael Atlanta Wound Care Center Doing business as

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1871916650",
    "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": "1007 S WILLIAM ST",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755513245",
            "telephone_number": "903-614-4200",
            "fax_number": "903-614-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH ARK-LA-TEX",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-29",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "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": "903-614-1000"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS St Michael Atlanta Wound Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHRISTUS St Michael Atlanta Wound Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.