NPIMap

Individual provider Active NPI

Anthony Dewayne Davis, M.D.

  • Family Medicine Physician
  • Lindale, TX
National Provider Identifier
1962446898
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K7710 Issued in TX
Practice address
1379 Brad Circle Ste a
Lindale, TX 75771
Phone
(903) 881-5165
Fax
(903) 881-5175
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K7710 TX Primary

Addresses

Primary practice location

1379 Brad Circle Ste a
Lindale, TX 75771

Mailing address

1379 Brad Circle Ste a
Lindale, TX 75771
Phone (903) 881-5165

Other practice location 1

1910 Roseland Blvd
Tyler, TX 75701-4246
Phone (903) 533-0644

Other identifiers 2

IdentifierTypeStateIssuer
116319807MedicaidTX
P00017436OtherMEDICARE RR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100104000456 TX Practitioner - Family Practice 2062553720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tyler Internal Medicine Associates, P.a 14 clinicians

Practice addresses (Care Compare)

1379 Brad Cir
Suite a
Lindale, TX 75771-6666
Phone (903) 881-5165

Hospital & facility affiliations

  • Paradigm Homecare Home health agency, Tyler, TX, CCN 457833
  • Traditions Health Home health agency, Tyler, TX, CCN 457951
  • Christus Homecare Home health agency, Tyler, TX, CCN 743197
  • Enhabit Home Health Home health agency, Tyler, TX, CCN 459457
  • Reliant at Home Home health agency, Tyler, TX, CCN 673165
  • Heart to Heart Hospice of Tyler LTD Hospice, Tyler, TX, CCN 451756
  • Traditions Health Hospice, Tyler, TX, CCN 671592
  • Harbor Hospice 27 LP Hospice, Tyler, TX, CCN 741565
  • Hospice of East Texas Hospice, Tyler, TX, CCN 451534
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
  • Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083
  • University of Texas Health Science Center at Tyler Hospital, Tyler, TX, CCN 450690
  • Christus Mother Frances Hospital Sulphur Springs Hospital, Sulphur Springs, TX, CCN 450236
  • Ut Health East Texas Rehabilitation Hospital Inpatient rehabilitation facility, Tyler, TX, CCN 453072
  • Avir at Lindale Nursing home, Lindale, TX, CCN 745021
  • The Center at Grande Nursing home, Tyler, TX, CCN 676443

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K7710TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler Internal Medicine Associates, P.a. Family Medicine CurrentSince Dec 15, 2013 Accepting new patients
Seniorrounds Medical, LLC Family Medicine CurrentSince Dec 1, 2024 Accepting new patients
Lindale Healthcare Operations LLC Past Accepting new patients
East Texas Medical Center Healthcare Associates Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients

Locations

1379 Brad Cir
Lindale, TX 75771
Phone (903) 881-5165

1379 Brad Cir
Ste A
Lindale, TX 75771
Phone (903) 881-5165

1910 Roseland Blvd
Tyler, TX 75701
Phone (903) 533-0644

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ADCFBA
  • Direct secure messaging: anthony.davis@tima.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avir at LindaleLindale, TX, CCN 745021 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2025
Mar 1, 2025
Traditions HealthTyler, TX, CCN 671592 Hospice Contracted Managing Employee Feb 1, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1962446898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1379 BRAD CIRCLE STE A",
            "city": "LINDALE",
            "state": "TX",
            "postal_code": "75771",
            "telephone_number": "903-881-5165",
            "fax_number": "903-881-5175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1379 BRAD CIRCLE STE A",
            "city": "LINDALE",
            "state": "TX",
            "postal_code": "75771",
            "telephone_number": "903-881-5165",
            "fax_number": "903-881-5175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1910 Roseland Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757014246",
            "country_code": "US",
            "telephone_number": "903-533-0644",
            "fax_number": "903-533-0441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ANTHONY",
        "middle_name": "DEWAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116319807",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00017436",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lindale, TX

Sources for this page

Verify at the official NPI Registry.