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ETMC PHYSICIAN GROUP INC.
NPI 1609382662
Internal Medicine - Cardiovascular Disease in Tyler, TX

Active since December 28, 2017CLIA Certified · 3 labs
1000 S BECKHAM AVE, TYLER, TX 75701(903) 590-5611(903) 535-6884 Get Directions Write a Review

NPPES record last updated: October 9, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 9, 2020, Apr 11, 2019, Dec 28, 2017 (3 updates tracked since 2017).

About Etmc Physician Group Inc. NPPES

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

ETMC PHYSICIAN GROUP INC. (NPI 1609382662) is a healthcare organization registered as a cardiovascular disease in Tyler, Texas and active in the NPI registry since December 2017. The organization holds 3 active CLIA laboratory certificates and lists Stephen C Petrovich, Evp And Secretary, as its authorized official.

NPPES Registry Identity

NPI1609382662
Entity TypeOrganization
Primary Taxonomy207RC0000X
Legal Business NameETMC PHYSICIAN GROUP INC.
Location Address1000 S BECKHAM AVETyler, TX 75701-1908
Mailing AddressPo Box 9477Tyler, TX 75711-9477 · (903) 594-2450 · Fax (903) 509-0493
Phone(903) 590-5611
Fax(903) 535-6884
Organization SubpartYesParent: Ahs East Texas Health System, Llc
Authorized OfficialStephen C PetrovichEvp And Secretary · (615) 296-3000
Enumeration DateDecember 28, 2017
Last NPPES UpdateOctober 9, 20203 updates tracked since enumeration
NPPES CertifiedOctober 9, 2020
✔ NPI 1609382662 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
1000 S BECKHAM AVE, Tyler, TX 75701
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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 the clinicians who bill Medicare through this organization, 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).

Clinicians Billing Medicare Through This Organization

629

Medicare enrollment records show 629 clinicians reassign Medicare billing to Etmc Physician Group Inc., which bills Medicare for the services they deliver. Of these, 40 practice at this address and 355 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 45

Nurse Practitioner179
Internal Medicine93
Family Practice69
Gastroenterology25
General Surgery23
Psychiatry21
Emergency Medicine19
Obstetrics/Gynecology19
37 other specialties181

Nearest to this location (20)

See all 629
Finette Alvarez, FNP
Nurse Practitioner
NPI 1184851693
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 594-2812
✔ PECOS✔ Accepts MedicareSame address
Melodie Blackmon, DO
Emergency Medicine
NPI 1689162257
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
Carlos Brown, M.D.
Emergency Medicine
NPI 1467653865
1000 S BECKHAM AVE EMERGENCY DEPARTMENT
Tyler, TX 75701
(903) 597-0351
✔ PECOS✔ Accepts MedicareSame address
Clarence Brown, M.D.
Internal Medicine
NPI 1538273180
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 596-3651
✔ PECOS✔ Accepts MedicareSame address
Robert Brown, NP
Nurse Practitioner
NPI 1649051962
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 592-6901
✔ PECOS✔ Accepts MedicareSame address
William Conner, M.D.
Family Practice
NPI 1932300266
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 571-4017
✔ PECOS✔ Accepts MedicareSame address
Arnulfo Duarte, DO
Internal Medicine
NPI 1053933416
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
Renee Hebbeler-Clark, M.D.
Critical Care (Intensivists)
NPI 1528258340
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 597-0351
✔ PECOS✔ Accepts MedicareSame address
Paul Kowalski, MD
Neurology
NPI 1952341067
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
Matthew Leveno, M.D
Critical Care (Intensivists)
NPI 1619186954
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
David Pollard, MD
Psychiatry
NPI 1487210894
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
Corey Bindner, MD
Orthopedic Surgery
NPI 1427552843
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 597-0351
✔ PECOS✔ Accepts MedicareSame address
Chase Culver, M.D.
Anesthesiology
NPI 1467870667
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 596-3504
✔ PECOS✔ Accepts MedicareSame address
Janey Dudley Deleeuw
Pediatric Medicine
NPI 1740868652
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5612
✔ PECOSSame address
Ali Irshad, M.D.
Thoracic Surgery
NPI 1548608219
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 531-6680
✔ PECOS✔ Accepts MedicareSame address
Roberto Lorenzi, MD
General Surgery
NPI 1235665613
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 535-2902
✔ PECOS✔ Accepts MedicareSame address
Amy Mikhael
Hospitalist
NPI 1356907786
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 590-5611
✔ PECOS✔ Accepts MedicareSame address
Daniel Rongo, MD
Pulmonary Disease
NPI 1780174110
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 592-6901
✔ PECOS✔ Accepts MedicareSame address
Sagarika Satyavada
Gastroenterology
NPI 1316331267
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 531-8950
✔ PECOS✔ Accepts MedicareSame address
Detlef Wencker, MD
Cardiovascular Disease (Cardiology)
NPI 1285634881
1000 S BECKHAM AVE
Tyler, TX 75701
(903) 595-5514
✔ PECOS✔ Accepts MedicareSame address
See all 629 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

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 45D1018247

Etmc Physician Group, Inc · Tyler, TX
Active · expires Aug 14, 2028
CLIA Number45D1018247
Laboratory TypePhysician Office
Certificate Effective DateAugust 15, 2026
Certificate Expiration DateAugust 14, 2028
Laboratory DirectorStephen Rydzak
Laboratory Phone(903) 590-5560
Laboratory LocationEtmc Physician Group, Inc1000 E 5th Street, Suite 200, Tyler, TX 75701
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 45D2330378

Etmc Physician Group, Inc Dba Ut Health Physicians · Tyler, TX
Active · expires Sep 15, 2027
CLIA Number45D2330378
Laboratory TypePhysician Office
Certificate Effective DateSeptember 16, 2025
Certificate Expiration DateSeptember 15, 2027
Laboratory DirectorJennie Y. Zheng
Laboratory Phone(903) 747-9550
Laboratory LocationEtmc Physician Group, Inc Dba Ut Health Physicians3753 Earl Campbell Parkway, Tyler, TX 75701
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 45D0924480

Etmc Physician Group, Inc · Tyler, TX
Active · expires Jun 25, 2027
CLIA Number45D0924480
Laboratory TypePhysician Office
Certificate Effective DateJune 26, 2025
Certificate Expiration DateJune 25, 2027
Laboratory DirectorSharon Secola
Laboratory Phone(903) 531-3800
Laboratory LocationEtmc Physician Group, Inc2608 Mcdonald Rd Suite 100, Tyler, TX 75701
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 1609382662. It was assigned to this organization in the NPPES registry on December 28, 2017.

Where is Etmc Physician Group Inc. located?

Etmc Physician Group Inc. is located at 1000 S Beckham Ave, Tyler, TX 75701. The listed phone number is (903) 590-5611.

What is Etmc Physician Group Inc.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Etmc Physician Group Inc. enrolled in Medicare?

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

How many clinicians bill Medicare through Etmc Physician Group Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 629 clinicians in 45 Medicare specialties reassign their Medicare billing to Etmc Physician Group Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (179), Internal Medicine (93) and Family Practice (69). Of these, 40 practice at this address and 355 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Etmc Physician Group Inc. hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

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 October 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.