DR. BRUCE ELKIN ELLERIN (NPI# 1285635052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285635052 |
| Entity Type | Individual |
| Full Name | DR. BRUCE ELKIN ELLERIN |
| Credential | M.D. |
| Practice Address |
721 Clinic Dr Tyler TX 75701-2043 |
| Practice Telephone | 9035356312 |
| Practice Fax Number | 9035356330 |
| Mailing Telephone | 9035336312 |
| Mailing Fax Number | 9035356330 |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2019-04-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
L8679 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA | 1825753 | 01 | |
| TX | 1984247-03 | 05 | |
| TX | 1984247-04 | 05 | |
| OXFORD | P3883771 | 01 | |
| AMERICHOICE | 010046338 | 01 | |
| HEALTHNET | 3K8111 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1801 S Palestine St, Athens, TX 75751 | 9036778300 | 9036778354 |
| Street Address |
721 CLINIC DR |
| City | TYLER |
| State | TX |
| Zip Code | 75701-2043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023011491 | Tyler Hematology Oncology, P.a. | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-05-31 |
| 1215468129 | Annala J. Shirley | Nurse Practitioner | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2017-03-22 |
| 1013372010 | Jeffrey Gilroy Md Pa | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2015-12-18 |
| 1326270984 | Tyler Texas Radiation Oncology Pa | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2009-08-17 |
| 1952504045 | Marc Edward Usrey | Internal Medicine | 721 Clinic Dr, Suite A, Tyler, TX 75701-2043 | 2007-06-07 |
| 1528134517 | Carlo Greg Niepes Demandante | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-11-28 |
| 1023121522 | East Texas Medical Center Cancer Institute | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-08-17 |
| 1801809074 | East Texas Radiation Oncology, Pa | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-08-15 |
| 1144248501 | Katrina Y. Glover | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2006-07-17 |
| 1407852700 | Joseph Todd Martins | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-06-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
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| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326270984 | Tyler Texas Radiation Oncology Pa | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2009-08-17 |
| 1144380684 | Lewis G Smith IIi | Radiology | 11937 Us Hwy 271, Tyler, TX 75708-3154 | 2006-12-12 |
| 1528134517 | Carlo Greg Niepes Demandante | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-11-28 |
| 1023121522 | East Texas Medical Center Cancer Institute | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-08-17 |
| 1801809074 | East Texas Radiation Oncology, Pa | Radiology | 721 Clinic Dr, Tyler, TX 75701-2043 | 2006-08-15 |
| 1538177217 | John Mathis Barnett | Radiology | 700 Olympic Plaza Cir, Suite 700, Tyler, TX 75701-1951 | 2006-08-04 |
| 1629010855 | Mark Wayne Saunders | Radiology | 910 E Houston St, Tyler, TX 75702-8369 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376154534 | Genesiscare Landmark Texas Cancer Care Pa | Radiology | 12606 Greenville Ave Ste 160, Dallas, TX 75243-1915 | 2020-08-12 |
| 1780232090 | Yaser Hasan | Radiology | 1911 Holcombe Blvd Apt 1615, Houston, TX 77030-4190 | 2019-08-29 |
| 1932557030 | Joseph Charles Arko | Radiology | 11532 Champions Green Dr, Houston, TX 77066-1070 | 2016-05-30 |
| 1962860221 | Urology San Antonio, P.a. | Radiology | 7718 Pasteur Dr, San Antonio, TX 78229-3402 | 2016-02-02 |
| 1619355419 | Jamie Pawlowski | Radiology | 2215 E Villa Maria Rd Ste 130, Bryan, TX 77802-2585 | 2015-05-12 |
| 1073915245 | Texas Radiation Oncology Medical Group, Pllc | Radiology | 2800 State Hwy 114 East, Suite 100, Trophy Club, TX 76262 | 2014-09-19 |
| 1548660186 | Century West Houston Pllc | Radiology | 2610 W Sam Houston Pkwy S, Houston, TX 77042-0008 | 2014-09-02 |
| 1275971533 | Corsicana Cancer Center | Radiology | 306 Hospital Dr., Corsicana, TX 75110 | 2013-06-10 |
| 1194079376 | Century Radiation Oncology Lubbock, Pllc | Radiology | 424 N. Utica, Lubbock, TX 79416-3035 | 2012-11-09 |
| 1285999698 | Robert Dery Lindberg | Radiology | 3757 Robinhood St, Houston, TX 77005-2027 | 2012-07-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.