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STEPHEN C SPAIN MD
NPI 1487686309
Family Medicine in Tyler, TX

Active since July 07, 2006PECOS EnrolledAccepts Medicare AssignmentCLIA 45D1107771 · Waiver
5040 KINSEY DR, SUITE 300, TYLER, TX 75703(903) 561-8300(903) 561-8327 Get Directions Write a Review

NPPES record last updated: November 20, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Stephen C Spain Md NPPES

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

STEPHEN C SPAIN MD (NPI 1487686309) is an individual family medicine provider in Tyler, Texas, licensed in Texas (G0154) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, holds a CLIA Waiver certificate valid through November 11, 2027, and is affiliated with Ut Health East Texas Tyler Regional Hospital.

NPPES Registry Identity

NPI1487686309
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameSTEPHEN C SPAINCredential: MD
Location Address5040 KINSEY DR, SUITE 300Tyler, TX 75703-3005
Mailing Address5040 Kinsey Dr, Suite 300Tyler, TX 75703-3005 · (903) 561-8300 · Fax (903) 561-8327
Phone(903) 561-8300
Fax(903) 561-8327
Sole ProprietorYes
Medical School CMSUniversity Of Texas Medical School At HoustonGraduated 1981
Enumeration DateJuly 7, 2006
Last NPPES UpdateNovember 20, 2009
✔ NPI 1487686309 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in TX · G0154
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
5040 KINSEY DR, Tyler, TX 75703
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Other Identifiers 6

Other89X859TX · Blue Cross
Medicare PIN89X859TX
Medicare PIN010054743TX
Other010054743TX · Railroad Medicare
Medicaid133341103TX
Medicare UPINC22090

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, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Stephen C Spain Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921180787
PECOS Enrollment IDI20080131000734
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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 of Waiver 45D1107771

Stephen C Spain MD · Tyler, TX
Active · expires Nov 11, 2027
CLIA Number45D1107771
Laboratory TypePhysician Office
Certificate Effective DateNovember 12, 2025
Certificate Expiration DateNovember 11, 2027
Laboratory DirectorStephen C. Spain
Laboratory Phone(903) 561-8300
Laboratory LocationStephen C Spain MD5040 Kinsey Dr Ste 300, Tyler, TX 75703
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 15

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
470 services270 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
249 services156 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
220 services219 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
210 services206 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
201 services184 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
85 services83 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ut Health East Texas Tyler Regional Hospital

Acute Care Hospitals · Tyler, TX
1/5 CMS rating
OwnershipProprietary
CMS Certification Number450083
Location1000 South Beckham AveTyler, TX 75701 · Smith County
Emergency services Birthing friendly

Christus Mother Frances Hospital

Acute Care Hospitals · Tyler, TX
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450102
Location800 East DawsonTyler, TX 75701 · Smith County
Emergency services Birthing friendly

Baylor Scott & White Texas Spine & Joint Hospital

Acute Care Hospitals · Tyler, TX
OwnershipPhysician
CMS Certification Number450864
Location1814 Roseland BoulevardTyler, TX 75701 · Smith County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75703 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
100%100 patients5/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 7

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
11 suppliers34 claims130 services$6.54 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers11 claims11 services$0.82 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
5 suppliers11 claims55 services$2.38 avg. paid by Medicare
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613
DME-Drugs Administered Through DME · category DG006N
1 supplier13 claims1,425 services$0.02 avg. paid by Medicare
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626
DME-Drugs Administered Through DME · category DG000N
1 supplier13 claims450 services$0.64 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
3 suppliers26 claims26 services$194.58 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

U.S. HEALTHWORKS MEDICAL GROUP OF TEXAS, INC.
Preventive Medicine (Occupational Medicine)
5040 KINSEY DR, SUITE 500
TYLER, TX 75703
Smith County (903) 561-2690
KIMBERLY VALLIA REEVES FNP
Nurse Practitioner (Family)
5040 KINSEY DR, SUITE 100
TYLER, TX 75703
Smith County (903) 534-0911
SI HU
Physical Therapist
5040 KINSEY DR, SUITE 500
TYLER, TX 75703
Smith County (903) 561-2690

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 Stephen Spain's NPI number?

The NPI number for Stephen Spain is 1487686309. It was assigned to this individual provider in the NPPES registry on July 7, 2006.

Where is Stephen Spain located?

Stephen Spain practices at 5040 Kinsey Dr Suite 300, Tyler, TX 75703. The listed phone number is (903) 561-8300.

What is Stephen Spain's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Stephen Spain enrolled in Medicare?

Yes. Stephen Spain is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Does Stephen Spain hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D1107771) is associated with this NPI, valid through November 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Stephen Spain 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 1 other insurer list Stephen Spain 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.

Is Stephen Spain affiliated with any hospitals?

According to CMS data, Stephen Spain is affiliated with Ut Health East Texas Tyler Regional Hospital, Christus Mother Frances Hospital and Baylor Scott & White Texas Spine & Joint Hospital.

When was this NPI record last updated?

The NPPES record for Stephen Spain was last updated on November 20, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.