NPIMap

Individual provider Active NPI

Kristen Hibbs Erickstad, MD

  • Rheumatology Physician
  • Longview, TX
National Provider Identifier
1972894616
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
Q7551 Issued in TX
Practice address
709 Hollybrook Dr Ste 4500
Longview, TX 75605-2412
Phone
(903) 757-6042
Fax
(903) 291-6286
NPI assigned
Apr 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X Q7551 TX Primary

Addresses

Primary practice location

709 Hollybrook Dr Ste 4500
Longview, TX 75605-2412

Mailing address

PO Box 610393
Dallas, TX 75261-0393
Phone (903) 291-6187

Other identifiers 1

IdentifierTypeStateIssuer
360637802MedicaidTX

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
I20160813000011 TX Practitioner - Rheumatology 0941508402 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
University of Texas Medical Branch at Galveston, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

709 Hollybrook Dr
Suite 4500
Longview, TX 75605-2412
Phone (903) 757-6042

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q7551TXMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Clinics of Longview CurrentSince Aug 1, 2016 Accepting new patients
Associated Clinicians of East Texas Rheumatology CurrentSince Sep 1, 2017 Accepting new patients
Associated Clinicians of East Texas Past Accepting new patients

Locations

709 Hollybrook Dr
Ste 4500
Longview, TX 75605
Phone (903) 291-6030

707 Hollybrook Dr
Ste 500
Longview, TX 75605
Phone (903) 232-8276

1009 N 4th St
Ste A
Longview, TX 75601
Phone (903) 757-3808

707 Hollybrook Dr
Ste 504
Longview, TX 75605
Phone (903) 232-8501

Interoperability endpoints

  • Direct secure messaging: kristen.erickstad.1@23550.direct.athenahealth.com

Organizations & group practices 3

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1972894616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-291-6187",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HOLLYBROOK DR STE 4500",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052412",
            "telephone_number": "903-757-6042",
            "fax_number": "903-291-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSTAD",
        "first_name": "KRISTEN",
        "middle_name": "HIBBS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-28",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "TX",
            "license": "Q7551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360637802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.