Individual provider Active NPI

Charles Courtney Burtis, MD

  • Emergency Medicine Physician
  • Longview, TX
National Provider Identifier
1992060057
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
Q2745 Issued in TX
Practice address
700 E Marshall Ave
Longview, TX 75601-5580
Phone
(903) 315-5383
NPI assigned
Jul 5, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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 Q2745 TX Primary

Addresses

Primary practice location

700 E Marshall Ave
Longview, TX 75601-5580

Mailing address

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-5383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ID2 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
I20150724011796 TX Practitioner - Emergency Medicine 7214164565 Reassigns benefits to 2 organizations
I20190627003138 ID Practitioner - Emergency Medicine 7214164565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

746 N College Rd
Twin Falls, ID 83301-3486

801 Pole Line Rd W
Twin Falls, ID 83301-5810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Clinic LLC Family Medicine CurrentSince Jun 1, 2019 Accepting new patients
Acs Primary Care Physicians Southwest, PA Emergency Medicine CurrentSince Jun 1, 2019 Accepting new patients
Acute Care Specialists Emergency Medicine CurrentSince Jan 1, 2016 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

323 E Hawkins Pkwy
Longview, TX 75605
Phone (903) 315-2000

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

811 S Washington Ave
Marshall, TX 75670
Phone (903) 315-1488

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 1

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": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1992060057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015580",
            "telephone_number": "903-315-5383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015580",
            "telephone_number": "903-315-5383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURTIS",
        "first_name": "CHARLES",
        "middle_name": "COURTNEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q2745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.