Northeast Texas Neurology Associates, P.a.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

E6235 Issued in TX

Legal business name

NORTHEAST TEXAS NEUROLOGY ASSOCIATES, P.A.

Practice address

505 S Fleishel Ave
Tyler, TX 75702-8413

Phone

(903) 526-7055

Fax

(903) 593-4303

NPI assigned

Nov 1, 2006

Last updated

Aug 16, 2022By 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. Gina M. Jetter, MDNPI 1346422532

Title

President

Phone

(903) 526-7055

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

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.

• Gina M. Jetter, MD

  • Neurology Physician
  • Tyler, TX
  • NPI 1346422532
  Medicare reassignment NPD Authorized official
• Fraquania Talesh Freeman, APRN

  • Primary Care Nurse Practitioner
  • Tyler, TX
  • NPI 1821499682
  Medicare reassignment NPD
• David Carney, M.D.

  • Orthopaedic Surgery Physician
  • Tyler, TX
  • NPI 1679579734
  NPD (past)
• Wayne E Hostetler, MD

  • Neurology Physician
  • Tyler, TX
  • NPI 1487649844
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1972680130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 S FLEISHEL AVE STE 800",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028413",
            "telephone_number": "903-526-7055",
            "fax_number": "903-593-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028413",
            "telephone_number": "903-526-7055",
            "fax_number": "903-593-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST TEXAS NEUROLOGY ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "JETTER",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-526-7055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "E6235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115025205",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143629701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Neurology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; 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.