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ETMC PHYSICIAN GROUP INC.
NPI 1235706581
Clinic/Center - Rural Health in Chandler, TX

Active since June 07, 2021CLIA 45D0922994 · Microscopy
125 STATE HIGHWAY 31 E, CHANDLER, TX 75758(903) 549-3862(903) 843-4965 Get Directions Write a Review

NPPES record last updated: June 7, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Etmc Physician Group Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETMC PHYSICIAN GROUP INC. (NPI 1235706581) is a healthcare organization registered as a rural health in Chandler, Texas and active in the NPI registry since June 2021. The organization holds a CLIA Microscopy certificate valid through December 10, 2026 and lists Stephen C. Petrovich, Evp, General Counsel, as its authorized official.

NPPES Registry Identity

NPI1235706581
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameETMC PHYSICIAN GROUP INC.
Location Address125 STATE HIGHWAY 31 EChandler, TX 75758-2376
Mailing Address1 Burton Hills Blvd Ste 250Nashville, TN 37215-6195 · (615) 296-3594
Phone(903) 549-3862
Fax(903) 843-4965
Organization SubpartNo
Authorized OfficialStephen C. PetrovichEvp, General Counsel · (615) 296-3594
Enumeration DateJune 7, 2021
NPPES CertifiedJune 7, 2021
✔ NPI 1235706581 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
125 STATE HIGHWAY 31 E, Chandler, TX 75758
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Etmc Physician Group Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by February 28, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateTexasEnrollment IDO20210910000248Part A · Rural Health ClinicDue dateFebruary 28, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D0922994

Etmc Physician Group, Inc · Chandler, TX
Active · expires Dec 10, 2026
CLIA Number45D0922994
Laboratory TypeOther
Certificate Effective DateDecember 11, 2024
Certificate Expiration DateDecember 10, 2026
Laboratory DirectorSamuel Raborn
Laboratory Phone(903) 849-3862
Laboratory LocationEtmc Physician Group, Inc125 Highway 31 East, Chandler, TX 75758
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANA ANN CARNS DNP APRN FNP-C
Nurse Practitioner (Family)
125 STATE HIGHWAY 31 E
CHANDLER, TX 75758
Henderson County (903) 849-3862
ANA RUTE BLOCH MURADAS MD
Pediatrics
125 STATE HIGHWAY 31 E
CHANDLER, TX 75758
Henderson County (903) 849-3862
SAMI MALAE HARRIS NP
Nurse Practitioner
125 STATE HIGHWAY 31 E
CHANDLER, TX 75758
Henderson County (903) 849-3862

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Etmc Physician Group Inc.'s NPI number?

The NPI number for Etmc Physician Group Inc. is 1235706581. It was assigned to this organization in the NPPES registry on June 7, 2021.

Where is Etmc Physician Group Inc. located?

Etmc Physician Group Inc. is located at 125 State Highway 31 E, Chandler, TX 75758. The listed phone number is (903) 549-3862.

What is Etmc Physician Group Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Is Etmc Physician Group Inc. enrolled in Medicare?

Yes. Etmc Physician Group Inc. is registered in the Medicare PECOS enrollment system.

When is Etmc Physician Group Inc.'s Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Texas, Rural Health Clinic) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Etmc Physician Group Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D0922994) is associated with this NPI, valid through December 10, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Etmc Physician Group Inc. accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Etmc Physician Group Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Etmc Physician Group Inc. was last updated on June 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.