Organization Active NPI

Interventional Cardiology

  • Cardiovascular Disease Physician
  • Houston, TX
National Provider Identifier
1013019157
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
INTERVENTIONAL CARDIOLOGY
Practice address
19255 Park Row Ste 204
Houston, TX 77084-7310
Phone
(281) 829-3860
Fax
(281) 829-3861
NPI assigned
Sep 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Pat Licht
Title
Practice MGR
Phone
(281) 829-3860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

19255 Park Row Ste 204
Houston, TX 77084-7310

Mailing address

19255 Park Row Ste 204
Houston, TX 77084-7310
Phone (281) 829-3860

Other practice location 1

707 S Fry Rd
Suite 380
Katy, TX 77450-2256
Phone (281) 829-3860

Other practice location 2

707 S Fry Rd
Suite 380
Katy, TX 77450-2256
Phone (281) 829-3860

Other identifiers 3

IdentifierTypeStateIssuer
DF8541OtherTXMEDICARE B RR
0035NZOtherTXBCBS
184963001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070129000285 TX Part B Supplier - Clinic/Group Practice 9931100344 Receives reassigned benefits from 1 practitioner
Practice locations: Houston, TX

National Provider Directory

National Provider Directory

Locations

707 S Fry Rd
Ste 380
Katy, TX 77450
Phone (281) 829-3860

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1013019157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19255 PARK ROW STE 204",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770847310",
            "telephone_number": "281-829-3860",
            "fax_number": "281-829-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19255 PARK ROW STE 204",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770847310",
            "telephone_number": "281-829-3860",
            "fax_number": "281-829-3861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 S Fry Rd",
            "address_2": "Suite 380",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "774502256",
            "country_code": "US",
            "telephone_number": "281-829-3860",
            "fax_number": "281-829-3861",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "707 S Fry Rd",
            "address_2": "Suite 380",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "774502256",
            "country_code": "US",
            "telephone_number": "281-829-3860",
            "fax_number": "281-829-3861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERVENTIONAL CARDIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "LICHT",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "PRACTICE MGR",
        "authorized_official_telephone_number": "281-829-3860"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE B RR",
            "identifier": "DF8541",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0035NZ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184963001",
            "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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.