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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: August 02, 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 Home State Health and more.Insurance ›

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 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.

Certificate of Waiver 45D1018247

Etmc Physician Group, Inc · Tyler, TX
Active · expires Aug 14, 2026
CLIA Number45D1018247
Laboratory TypePhysician Office
Certificate Effective DateAugust 15, 2024
Certificate Expiration DateAugust 14, 2026
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.

Other Providers at the Same Location NPPES 20

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

MUHAMMAD KAFEEL SARWAR M.D.
Internal Medicine
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 590-5611
JOHN GLYNN JEANSONNE CRNA
Nurse Anesthetist, Certified Registered
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 526-1068
ARAMISH SAEED KHAN
Student in an Organized Health Care Education/Training Program
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 594-2269
DR. FARZAD FAKOURI M.D. , MPH
Internal Medicine
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 590-5611
ARNULFO DUARTE DO
Internal Medicine
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 590-5611
HAROLD RICHIE BANDALAN CRNA
Nurse Anesthetist, Certified Registered
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 526-1068
TYLER REGIONAL HOSPITAL LLC
Surgery (Trauma Surgery)
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 597-0351
DR. JACKIE ROSE MD
Emergency Medicine
1000 S BECKHAM AVE
TYLER, TX 75701
Smith County (903) 597-0351

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.

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 Home State Health, Ambetter from Louisiana Healthcare Connections and Ambetter from Magnolia Health and 5 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 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.