East Texas Spine Institute, PA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

K1283 Issued in TX

Legal business name

EAST TEXAS SPINE INSTITUTE, PA

Practice address

3110 Park Center Dr
Tyler, TX 75701-9215

Phone

(903) 593-9999

Fax

(903) 526-4239

NPI assigned

Nov 14, 2007

Organization subpart

No

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

Authorized official

Name

Ritesh R PrasadNPI 1952308777

Title

Owner

Phone

(903) 593-9999

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ritesh R Prasad, MD

  • Physical Medicine & Rehabilitation Physician
  • Tyler, TX
  • NPI 1952308777
  Medicare reassignment NPD Authorized official
• Jared Anthony Crook, FNP

  • Family Nurse Practitioner
  • Tyler, TX
  • NPI 1417420498
  Medicare reassignment NPD
• Haley Brooke Krebs, FNP-C

  • Family Nurse Practitioner
  • Longview, TX
  • NPI 1346002144
  Medicare reassignment NPD

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1992985394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130940",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757130940",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 PARK CENTER DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019215",
            "telephone_number": "903-593-9999",
            "fax_number": "903-526-4239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS SPINE INSTITUTE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "RITESH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-593-9999"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "K1283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Texas Physician Assistant Services
• East Texas Podiatry Associates, P.C.
• East Texas Priority Medical Transportation LLC
• East Texas Psychiatry and Counseling PLLC
• East Texas Radiation Oncology, PA
• East Texas Therapy and Rehab
• East Texas Vascular Associates, P.a.
• Eastwood Care & Rehab LLC
• Catherine L Eaton
• Chris Eaton, MA, LPC

• Physical Medicine & Rehabilitation Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.