Active NPI
Amy Mynderse, M.D.
- Internal Medicine Physician
- Houston, TX
National Provider Identifier
1003848342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- M2721
- Practice address
- 1701 Sunset Blvd
Houston, TX 77005-1713 - Phone
- (713) 526-5511
- Fax
- (713) 520-4755
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | M2721 | TX | |
| Internal Medicine Physician | 207R00000X | M2721 | TX | Primary |
Addresses
Primary practice location
1701 Sunset Blvd
Houston, TX 77005-1713
Mailing address
PO Box 4767
Houston, TX 77210-4767
Phone (713) 526-5511
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182194401 | Medicaid | TX | |
| P00359984 | Other | TX | RAILROAD MEDICARE |
| 8V3667 | Other | TX | BLUE CROSS BLUE SHIELD OF TEXAS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 25, 2019 through Jul 25, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M2721 | TX | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454976000000",
"number": "1003848342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4767",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772104767",
"telephone_number": "713-526-5511",
"fax_number": "713-520-4755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 SUNSET BLVD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770051713",
"telephone_number": "713-526-5511",
"fax_number": "713-520-4755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYNDERSE",
"first_name": "AMY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2016-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "TX",
"license": "M2721",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "TX",
"license": "M2721",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182194401",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00359984",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
"identifier": "8V3667",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.