Space Center Primary Care, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

Q4875 Issued in TX

Legal business name

SPACE CENTER PRIMARY CARE, PLLC

Practice address

907 Bay Area Blvd Ste B
Houston, TX 77058-2665

Phone

(281) 286-6000

Fax

(281) 488-8686

NPI assigned

Oct 28, 2016

Last updated

Nov 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Deran Y Wong, MDNPI 1194089722

Title

Physician

Phone

(281) 286-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deran Y. Wong, MD

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1194089722
  Medicare reassignment NPD Authorized official
• Kin Yee Chan, M.D.

  • Family Medicine Physician
  • Houston, TX
  • NPI 1770584385
  NPD
• Paul Tse, M.D.

  • Internal Medicine Physician
  • Sugar Land, TX
  • NPI 1629279153
  NPD (past)

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

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480291200000",
    "number": "1033661715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 BAY AREA BLVD STE B",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582665",
            "telephone_number": "281-286-6000",
            "fax_number": "281-488-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 BAY AREA BLVD STE B",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582665",
            "telephone_number": "281-286-6000",
            "fax_number": "281-488-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE CENTER PRIMARY CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-28",
        "last_updated": "2016-11-28",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "DERAN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "281-286-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "Q4875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "454495ZRZ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Soza, MA LPC-A
• Sharon Soza, COTA
• Sozo Counseling Services
• SP Psychiatric Consulting PLLC
• Space Center Medical Equipment, Inc
• Space Center Respiratory Equipment LLP (Nasa Medical Supply)
• Space Center Sa Services, Inc
• Space Center Sa Services, Inc
• Space City Audiology PLLC
• Space City EMS LLC

• Primary Care Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; 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.