East Lake Medical, PLLC
NPI 1497494777 · Nurse Practitioner · Tyler, TX
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
East Lake Medical, PLLC is a Nurse Practitioner organization in Tyler, TX (NPI 1497494777).
Provider details
- NPI number
- 1497494777
- Entity type
- Organization
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Jena Decanter, Nurse Practitioner(903) 650-8619
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2022-06-03
- Last updated
- 2022-06-03
- Certified
- 2022-06-03
Frequently asked questions
- What is East Lake Medical, PLLC's NPI number?
- East Lake Medical, PLLC's National Provider Identifier (NPI) is 1497494777, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is East Lake Medical, PLLC?
- East Lake Medical, PLLC is classified in the NPPES registry as Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers).
- Where is East Lake Medical, PLLC located?
- East Lake Medical, PLLC's practice location on file with NPPES is 11980 State Highway 64 E Ste G, Tyler, TX 75707-2541.
- What is East Lake Medical, PLLC's phone number?
- The practice phone number listed in the NPPES registry for East Lake Medical, PLLC is (903) 650-8619.
- Does East Lake Medical, PLLC accept Medicare?
- East Lake Medical, PLLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for East Lake Medical, PLLC?
- The authorized official listed on East Lake Medical, PLLC's NPPES record is Jena Decanter, Nurse Practitioner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is East Lake Medical, PLLC's NPI active?
- Yes — East Lake Medical, PLLC's NPI (1497494777) is active in the NPPES registry as of the last update on 2022-06-03.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.