NPIMap

Organization Active NPI

Lakeside Gastroenterology and Liver Specialists, PLLC

  • Gastroenterology Physician
  • Conroe, TX
National Provider Identifier
1033439781
Registry record updated Oct 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LAKESIDE GASTROENTEROLOGY AND LIVER SPECIALISTS, PLLC
Practice address
690 S Loop 336 W Ste 215
Conroe, TX 77304-3322
Phone
(936) 828-3962
NPI assigned
Jun 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2020

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

Authorized official

Name
Nelson A Tajong, M.DNPI 1760436182
Title
Owner
Phone
(410) 530-5310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

690 S Loop 336 W Ste 215
Conroe, TX 77304-3322

Mailing address

86 Lenox Hill Dr
Spring, TX 77382-2527

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100914000402 TX Part B Supplier - Clinic/Group Practice 6507981651 Receives reassigned benefits from 10 practitioners
Practice locations: Conroe, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2308010Lakeside Gastroenterology and Liver Specialists690 South Loop 336 West Ste 215, Conroe, TX 77304ComplianceJan 26, 2027

National Provider Directory

National Provider Directory

Locations

690 S Loop 336 W
Ste 215
Conroe, TX 77304
Phone (936) 228-9980

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AAEABA

Practitioners & affiliated clinicians

Practitioners 10

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": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1033439781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 LENOX HILL DR",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773822527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 W STE 215",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043322",
            "telephone_number": "936-828-3962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE GASTROENTEROLOGY AND LIVER SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "TAJONG",
        "authorized_official_first_name": "NELSON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-530-5310",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.