Texas Modern Gastroenterology

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

TEXAS MODERN GASTROENTEROLOGY

Practice address

1216 Church St
Sulphur Springs, TX 75482-2108

Phone

(903) 588-2222

Fax

(903) 588-2225

NPI assigned

Jan 7, 2021

Last updated

Jan 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Vivian Sami Ebrahim, MDNPI 1073870440

Title

Physician Owner/Physician

Phone

(214) 729-0111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IJDDCD

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.

• Vivian Sami Ebrahim, M.D.

  • Gastroenterology Physician
  • Sulphur Springs, TX
  • NPI 1073870440
  Medicare reassignment Care Compare group NPD Authorized official
• Mena Milad, M.D.

  • Gastroenterology Physician
  • Sulphur Springs, TX
  • NPI 1912265968
  Medicare reassignment Care Compare group NPD
• Josue Cruz

  • Physician Assistant
  • Dallas, TX
  • NPI 1801621123
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1902494743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 CHURCH ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822108",
            "telephone_number": "903-588-2222",
            "fax_number": "903-588-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 CHURCH ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822108",
            "telephone_number": "903-588-2222",
            "fax_number": "903-588-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS MODERN GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-07",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "EBRAHIM",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "SAMI",
        "authorized_official_title_or_position": "PHYSICIAN OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "214-729-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christa Teer, PTA
• Romerico Engle Temporal
• Courtney R Tennent, APN
• Wineshet Teshome
• Texas Em-1 Medical Services, PA
• Texas Pelvic Health LLC
• Texas Regional Anesthesia Medical Group, P.a
• The Patient's Choice
• Ashlei Thomas
• Kaleigh A Thompson, P.T.A.

• Gastroenterology Physician in Sulphur Springs, TX
• Providers in Sulphur Springs, TX by specialty
• Gastroenterology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.