Organization Active NPI

Northwoods Urology of Texas PLLC

  • Urology Physician
  • Shenandoah, TX
National Provider Identifier
1043578859
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
NORTHWOODS UROLOGY OF TEXAS PLLC
Practice address
135 Vision Park Blvd
Shenandoah, TX 77384-3001
Phone
(281) 404-3000
Fax
(936) 273-6911
NPI assigned
Apr 30, 2012
Last updated
Dec 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Paul R Kenworthy, M.D.NPI 1295795698
Title
Managing Partner
Phone
(281) 404-3000

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X

Addresses

Primary practice location

135 Vision Park Blvd
Shenandoah, TX 77384-3001

Mailing address

135 Vision Park Blvd
Shenandoah, TX 77384-3001
Phone (281) 404-3000

Other practice location 1

350 Kingwood Medical Dr Ste 140
Kingwood, TX 77339-6406
Phone (281) 404-3000

Other practice location 2

100 Medical Center Pkwy Ste 600
Huntsville, TX 77340-4965
Phone (281) 404-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120829000365 TX Part B Supplier - Clinic/Group Practice 3173770005 Receives reassigned benefits from 3 practitioners
Practice locations: Huntsville, TX; Kingwood, TX; Shenandoah, TX

National Provider Directory

National Provider Directory

Locations

350 Kingwood Medical Dr
Ste 140
Kingwood, TX 77339
Phone (281) 359-1911

Interoperability endpoints

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1043578859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 VISION PARK BLVD",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843001",
            "telephone_number": "281-404-3000",
            "fax_number": "936-273-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 VISION PARK BLVD",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843001",
            "telephone_number": "281-404-3000",
            "fax_number": "936-273-6911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Kingwood Medical Dr Ste 140",
            "address_purpose": "LOCATION",
            "city": "Kingwood",
            "state": "TX",
            "postal_code": "773396406",
            "country_code": "US",
            "telephone_number": "281-404-3000",
            "fax_number": "936-273-6911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Medical Center Pkwy Ste 600",
            "address_purpose": "LOCATION",
            "city": "Huntsville",
            "state": "TX",
            "postal_code": "773404965",
            "country_code": "US",
            "telephone_number": "281-404-3000",
            "fax_number": "936-273-6911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWOODS UROLOGY OF TEXAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "KENWORTHY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "281-404-3000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; 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.