NPIMap

Individual provider Active NPI

Tricia Punsalan, M.D.

  • Family Medicine Physician
  • Conroe, TX
National Provider Identifier
1003020504
Registry record updated Jul 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N2740 Issued in TX
Practice address
704 Old Montgomery Rd
Conroe, TX 77301-2740
Phone
(936) 539-4004
Fax
(936) 521-3964
NPI assigned
May 10, 2007
Last updated
Jul 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X N2740 TX
Family Medicine Physician 207Q00000X N2740 TX Primary

Addresses

Primary practice location

704 Old Montgomery Rd
Conroe, TX 77301-2740

Mailing address

504 Medical Center Blvd
Conroe, TX 77304-2808
Phone (936) 718-3831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110131000597 TX Practitioner - Family Practice 6800075201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Docs PAGroup PAC ID 7517052822, 9 clinicians

Practice addresses (Care Compare)

Montgomery, TX 77316
Phone (936) 588-6300

504 Medical Ctr Blvd
Conroe, TX 77304-2808
Phone (936) 588-6300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
CHG Hospital Conroe, LLC Past Accepting new patients
PH Ops of Conroe LLC Past Accepting new patients
Winnie-Stowell Hospital District Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The BrightpointeConroe, TX, CCN 676420 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2023
Feb 1, 2023
Enhabit HospicePasadena, TX, CCN 671703 Hospice Contracted Managing Employee Mar 10, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467676800000",
    "number": "1003020504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 MEDICAL CENTER BLVD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042808",
            "telephone_number": "936-718-3831",
            "fax_number": "888-501-5341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 OLD MONTGOMERY RD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773012740",
            "telephone_number": "936-539-4004",
            "fax_number": "936-521-3964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNSALAN",
        "first_name": "TRICIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-10",
        "last_updated": "2016-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "N2740",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N2740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.