Individual provider Active NPI

David Mark Easty, M.D.

  • Emergency Medicine Physician
  • Fort Stewart, GA
National Provider Identifier
1952480485
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9900036 Issued in NC
Practice address
1061 Harmon Ave Ste 1D03
Fort Stewart, GA 31314-5641
Phone
(912) 435-6633
NPI assigned
Nov 3, 2006
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9900036 NC Primary

Addresses

Primary practice location

1061 Harmon Ave Ste 1D03
Fort Stewart, GA 31314-5641

Mailing address

6600 Van Aalst Blvd
Fort Moore, GA 31905-2102
Phone (762) 408-2242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090706000410 GA Practitioner - Emergency Medicine 2062563901
I20151123000460 TX Practitioner - Emergency Medicine 2062563901 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9900036NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Third Coast Emergency Physicians Southwest PA Emergency Medicine CurrentSince Feb 11, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Mar 8, 2016 Accepting new patients
Travis County Emergency Physicians PA Emergency Medicine CurrentSince Dec 16, 2021 Accepting new patients
Tift Regional Health System Inc. CurrentSince Mar 8, 2016 Accepting new patients

Locations

1622 Madison Ave
Tifton, GA 31794
Phone (229) 387-8061

7900 Ranch Road 1826
Austin, TX 78737
Phone (512) 324-5305

2615 Southwest Fwy
Ste 140
Houston, TX 77098
Phone (713) 441-2779

6001 Kyle Pkwy
Kyle, TX 78640
Phone (512) 504-5000

100 Medical Pkwy
Lakeway, TX 78738
Phone (512) 206-8100

1310 E League City Pkwy
League City, TX 77573
Phone (346) 427-5050

11525 Broadway St
Pearland, TX 77584
Phone (713) 363-8020

4103 N Loop 1604 W
San Antonio, TX 78249
Phone (210) 572-8415

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1952480485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE STE 1D03",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASTY",
        "first_name": "DAVID",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "9900036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stewart, GA

Sources for this page

Verify at the official NPI Registry.