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Active NPI 1730199563 Individual Practitioner Male Practitioner

Kevin P Scully , PA-C

Physician Assistant • Tyler, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Kevin Scully, PA-C is a certified Physician Assistant practicing in Tyler, TX. With approximately 20 years of clinical experience since completing medical education in 2006, Kevin Scully delivers high-quality medical care to the local community at 2210 THREE LAKES PKWY STE 100.

Kevin Scully is affiliated with Etmc Physician Group, Inc. and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, dexamethasone sodium phosphate, 1 mg, established patient outpatient office visit, injection beneath the skin or into muscle for therapy, diagnosis, or prevention. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

2210 Three Lakes Pkwy Ste 100

Tyler, TX 757030642

Telephone 9037474050
Fax 9037474075

Medicare Profile & Education

Medical School

Other

Graduation Year

2006

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Tyler, TX

Senior Veteran Specialist (>20 Yrs)
Practitioner Clinical Experience
20 Yrs +2.9 yrs vs City Avg
City Avg: 17.1 Yrs
State Avg: 13.9 Yrs
Regional Practice Density
99 Specialists

Practicing in Tyler, TX (11140 Statewide)

Telehealth Adoption Rate
6.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
63.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Scully (20 Years) 20 Yrs
Tyler Specialty Average (17.1 Years) 17.1 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
J1100 Injection, dexamethasone sodium phosphate, 1 mg
88 11 $12.00 $0.12
99213 Established patient office or other outpatient visit, typically 15 minutes
59 55 $160.00 $59.94
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention
17 13 $25.00 $16.74
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more
11 11 $239.00 $88.67
J1040 Injection, methylprednisolone acetate, 80 mg
11 11 $55.00 $12.93

Medical Specialties & State Licenses

CMS Verified: 2026-02-05
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License TX PA03374

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Hospital & Practice Group Affiliations

Etmc Physician Group, Inc.

2210 Three Lakes Pkwy, Tyler, TX 757030642

Phone: 9037474050

Etmc Physician Group, Inc.

18118 Fm 344, Flint, TX 757626010

Phone: 9038253292

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

9 Associated Practitioners
Dr. Kurtis Kostan , MD

Internal Medicine

NPI 1134516172

Doctor of Medicine (M.D.)

Dr. Bryan Hyland , MD

Family Medicine

NPI 1215972591

Doctor of Medicine (M.D.)

Amie Bevis , NP

Nurse Practitioner

NPI 1225765795

Nurse Practitioner

NPI 1285251181

Doctor of Audiology

Dr. Christopher Perro , MD

Otolaryngology - Otolaryngology/Facial Plastic Surgery

NPI 1346462496

Doctor of Medicine (M.D.)

Tammye Willis , APRN, FNP-C

Nurse Practitioner - Family

NPI 1598279788

Advanced Practice Registered Nurse, Family Nurse Practitioner (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

15 Historical Events
📍
Updated Practice Location February 05, 2026

Registered at 2210 THREE LAKES PKWY STE 100, TYLER, TX 757030642 (Tel: 9037474050)

📍
Updated Business Mailing Address February 05, 2026

Registered at 2210 THREE LAKES PKWY STE 100, TYLER, TX 757030642 (Tel: 9037474050)

📍
Updated Practice Location August 17, 2018

Registered at 6210 S BROADWAY AVE, TYLER, TX 757034413 (Tel: 9035792718)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 17, 2018

Physician Assistant (License #PA03374 in TX)

NPI Profile Active April 19, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location April 19, 2017

Registered at 837 S FLEISHEL AVE, TYLER, TX 757012017 (Tel: 9035260450)

📍
Updated Business Mailing Address April 19, 2017

Registered at PO BOX 99371, FORT WORTH, TX 761990371 (Tel: 6828851855)

👤
Provider Name / Credentials Updated April 19, 2017

Recorded as KEVIN SCULLY, PAC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2017

Physician Assistant (License #PA03374 in TX)

NPI Profile Active April 20, 2012

NPI status registered as active in NPPES database

📍
Updated Practice Location April 20, 2012

Registered at 1500 COOPER ST, FORT WORTH, TX 761042710 (Tel: 6828857080)

📍
Updated Business Mailing Address April 20, 2012

Registered at PO BOX 99371, FORT WORTH, TX 761990371 (Tel: 6828851855)

👤
Provider Name / Credentials Updated April 20, 2012

Recorded as KEVIN SCULLY, PAC

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 20, 2012

Physician Assistant (License #PA03374 in TX)

🟢
Initial NPI Registration & Enumeration August 08, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1730199563
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 08, 2006
Last Update: February 05, 2026
Sole Proprietor: No

Mailing Address

2210 Three Lakes Pkwy Ste 100

Tyler, TX 757030642

Phone: 9037474050

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.