- Medicare Primary Care in Tyler, TX

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is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Tyler, Texas. The current practice location for is 13172 State Highway 64 E, Tyler, Texas. For appointments, you can reach them via phone at (903) 535-9041. The mailing address for is 523 S Fannin Ave, Tyler, Texas and phone number is (903) 535-9041.

is licensed to practice in Texas (license number ). The clinic also participates in the medicare program and its NPI number is 1144575820. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (903) 535-9041.

Contact Information

13172 State Highway 64 E
Tyler
TX 75707-5340
(903) 535-9041
Not Available

Map and Direction


Primary Care Clinic Profile

Full Name
SpecialityClinic/Center
Location13172 State Highway 64 E, Tyler, Texas
Authorized Official Name and PositionKristen S Harris (CHIEF EXECUTIVE OFFICER)
Authorized Official Contact9035359041
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address

523 S Fannin Ave
Tyler
TX 75702-8204

Ph: (903) 535-9041
13172 State Highway 64 E
Tyler
TX 75707-5340

Ph: (903) 535-9041

NPI Details:

NPI Number1144575820
Provider Enumeration Date07/18/2012
Last Update Date07/15/2024

Medicare PECOS Information:

Medicare PECOS PAC ID4587812888
Medicare Enrollment IDO20120911000666

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1144575820NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
208D00000XGeneral Practice (* (Not Available))Secondary
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (Texas)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:
Provider NameMarel A Hanks
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1306810593
PECOS PAC ID: 4385627306
Enrollment ID: I20040610001221
Provider NameTamara L Jones
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1952439432
PECOS PAC ID: 3971579046
Enrollment ID: I20040909000602
Provider NameToni L Richey
Provider TypePractitioner - Certified Nurse Midwife (cnm)
Provider IdentifiersNPI Number: 1265560205
PECOS PAC ID: 1254390248
Enrollment ID: I20041006000169
Provider NameJeffrey P Smith
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1760578835
PECOS PAC ID: 5294648366
Enrollment ID: I20050103000561
Provider NameJacqueline Catney Dubois
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1043206147
PECOS PAC ID: 4587689146
Enrollment ID: I20051012000813
Provider NameStephen K Patrick
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1174542815
PECOS PAC ID: 6608970363
Enrollment ID: I20070406000104
Provider NameCheryl Polkowski
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1194882241
PECOS PAC ID: 4385606698
Enrollment ID: I20081003000052
Provider NameWayne Karaki
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1871582924
PECOS PAC ID: 2264571710
Enrollment ID: I20091123000602
Provider NamePaul W Pitts
Provider TypePractitioner - Hospitalist
Provider IdentifiersNPI Number: 1871568535
PECOS PAC ID: 4385779800
Enrollment ID: I20100322000882
Provider NameAmanda Lynn Harris
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1336159128
PECOS PAC ID: 2264556927
Enrollment ID: I20100901000642
Provider NameJoseph L Petty
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1649461211
PECOS PAC ID: 1557486404
Enrollment ID: I20100915000587
Provider NameRachel Ann Everson
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1992936603
PECOS PAC ID: 0648469148
Enrollment ID: I20110114000412
Provider NameNicholas Paul Luzietti
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1932119443
PECOS PAC ID: 6709065444
Enrollment ID: I20110126000862
Provider NameJudith D Sutherland
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1851611503
PECOS PAC ID: 6608046966
Enrollment ID: I20110824000878
Provider NameKatherine S Root
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1083932818
PECOS PAC ID: 2567606445
Enrollment ID: I20130916000064
Provider NameEduardo Torres
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1255442653
PECOS PAC ID: 9335165075
Enrollment ID: I20131018001458
Provider NameJosephine Katherine Porter
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1346429677
PECOS PAC ID: 1254502511
Enrollment ID: I20140213000207
Provider NameLarry Shane Hilton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1720153224
PECOS PAC ID: 4385643543
Enrollment ID: I20140707000636
Provider NameLucianne Marin
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1821024654
PECOS PAC ID: 4385782325
Enrollment ID: I20140801001006
Provider NameLamesa L Bell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1548663784
PECOS PAC ID: 8426270042
Enrollment ID: I20141117000405
Provider NameLell Alyne Pinkston
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1851797740
PECOS PAC ID: 8224353867
Enrollment ID: I20150203000208
Provider NameEdileola Makinde
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1811954852
PECOS PAC ID: 3476655721
Enrollment ID: I20160311001708
Provider NameZareh H Khachikian
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1215084603
PECOS PAC ID: 3971698069
Enrollment ID: I20160504002547
Provider NameStacy R Fogle
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376093278
PECOS PAC ID: 6305126616
Enrollment ID: I20161202001064
Provider NameJuan P Garrido Morales
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1285073288
PECOS PAC ID: 5496054504
Enrollment ID: I20170131001527
Provider NameKhotwanaeya A Mwamba
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1205198421
PECOS PAC ID: 0749593820
Enrollment ID: I20171017003312
Provider NameLorena Santoro
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1114307790
PECOS PAC ID: 5991003485
Enrollment ID: I20180716001418
Provider NameRabiah Zafar
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1235533027
PECOS PAC ID: 3072861830
Enrollment ID: I20180810000344
Provider NameSandra J Gooding
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1811541923
PECOS PAC ID: 5496083503
Enrollment ID: I20190828001314
Provider NameMatthew Bryan Boehme
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1215460183
PECOS PAC ID: 4981026481
Enrollment ID: I20200629002115
Provider NameDavid Rice
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1902867260
PECOS PAC ID: 1456452796
Enrollment ID: I20201022004220
Provider NameBhavani Suryadevara
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1710211578
PECOS PAC ID: 6002041001
Enrollment ID: I20210115001146
Provider NameJoshua Timothy Morgan
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1003304452
PECOS PAC ID: 4082978325
Enrollment ID: I20210512001730
Provider NameAngelica Maria Larios
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1912361288
PECOS PAC ID: 8426461104
Enrollment ID: I20210513001697
Provider NameCasie May Zarate
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1447925821
PECOS PAC ID: 8325446719
Enrollment ID: I20211015001369
Provider NameVictoria Childers
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1134733520
PECOS PAC ID: 6901290824
Enrollment ID: I20220218000587
Provider NameRoger Pearce
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1295706273
PECOS PAC ID: 2961569918
Enrollment ID: I20220502000791
Provider NameLakisha Nashun Bennings
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1609526771
PECOS PAC ID: 9537536743
Enrollment ID: I20221101000978
Provider NameRachel Rene Baber
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1396469839
PECOS PAC ID: 5496122129
Enrollment ID: I20221109000461
Provider NameValerie B Smith
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1073625737
PECOS PAC ID: 4688045073
Enrollment ID: I20230123001325
Provider NameDeborah Garganera Ledesma
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1114625670
PECOS PAC ID: 7012381635
Enrollment ID: I20230322002746
Provider NameAmanda Michelle Walsh
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1003517244
PECOS PAC ID: 8628433745
Enrollment ID: I20230425001412
Provider NameBeverly S Hargrove
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1417113523
PECOS PAC ID: 9739078668
Enrollment ID: I20230524000036
Provider NameJohn David Martino
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1285255877
PECOS PAC ID: 3678994746
Enrollment ID: I20230622000701
Provider NameBlake M Vincent
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1083747190
PECOS PAC ID: 2567815673
Enrollment ID: I20240125000168
Provider NameGerard E Vallejo
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1285029538
PECOS PAC ID: 0840634754
Enrollment ID: I20240220000493
Provider NameMacy D Sims
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1295381010
PECOS PAC ID: 7113362120
Enrollment ID: I20240229002659
Provider NameShweta Thambad
Provider TypePractitioner - Dentist
Provider IdentifiersNPI Number: 1831864685
PECOS PAC ID: 6406292127
Enrollment ID: I20240315001751
Provider NameKelvin S Darr
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1235337445
PECOS PAC ID: 3173060027
Enrollment ID: I20240808004333
Provider NameJoseph Ray Watt
Provider TypePractitioner - Mental Health Counselor
Provider IdentifiersNPI Number: 1487395463
PECOS PAC ID: 7113465915
Enrollment ID: I20240812001908
Provider NameSymira Von'yea Dearman
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1245082700
PECOS PAC ID: 9638619455
Enrollment ID: I20240909000084
Provider NameDalia Morad
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1720657570
PECOS PAC ID: 2062813108
Enrollment ID: I20240909000444
Provider NameChelsea Carnes
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881416006
PECOS PAC ID: 9335673243
Enrollment ID: I20241114003869

Reviews and Comments


Clinic/Center in Tyler, TX

Pure Radiance Laser Retreat
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 6722 S Broadway Ave, Tyler, TX 75703
Phone: 903-561-0300    
Clifford D. Mullins, D.c., P.c.
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 14653 Eastside Rd, Tyler, TX 75707
Phone: 903-566-4449    
Frank P Reuter Jr Md Pa
Primary Care Clinic
Medicare: Medicare Enrolled
Practice Location: 712 S Bois D Arc Ave, Tyler, TX 75701
Phone: 903-597-5579    Fax: 903-597-5722
David W Ball Md Internal Medicine Pllc
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 5407 New Copeland Rd Ste 200, Tyler, TX 75703
Phone: 903-330-2081    Fax: 903-630-9309

Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 5605 Old Bullard Rd Ste B, Tyler, TX 75703
Phone: 903-630-5595    Fax: 903-630-5599

Primary Care Clinic
Medicare: Medicare Enrolled
Practice Location: 510 S Southwest Loop 323 Ste 140, Tyler, TX 75702
Phone: 903-530-0240    
Bwbl Group
Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 6770 Old Jacksonville Hwy Ste 101, Tyler, TX 75703
Phone: 903-352-3250    Fax: 903-221-9183

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.