Providian Health Care Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

010276 Issued in TX

Legal business name

PROVIDIAN HEALTH CARE INC.

Practice address

2421 Roy Rd Ste 101
Pearland, TX 77581-8601

Phone

(281) 997-6272

Fax

(281) 997-6275

NPI assigned

May 5, 2006

Last updated

Apr 7, 2021By 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

Merrill Mohan

Title

Administrator

Phone

(281) 997-6272

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063460483. Details of each certification follow.

• CCN 457952 Home health agency · Active · Details

Home health agency certification: CCN 457952

Legal name

PROVIDIAN HEALTH CARE INC.

Doing business as

QUANTUM HEALTHCARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 30, 2005

Last certification

Feb 27, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jan 8, 2004 in TX

Enrollment address

2421 Roy Rd
Ste 101
Pearland, TX 77581-8601

Listed as

Providian Health Care IncCCN 457952 · All quality measures

Overall star rating

4.5 of 5

Ownership

Proprietary

Certified

Nov 30, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Immaculate Home Health, Inc

  • Home Health Agency
  • Pearland, TX
  • NPI 1245292382

  Marathon Healthgroup Inc.

  CMS ownership

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Riddhi Umesh Bodani, MD

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1639738750

  Home health agency

  Care Compare affiliation
• Mary W Kaburu

  • Family Nurse Practitioner
  • Houston, TX
  • NPI 1316327026

  Home health agency

  Care Compare affiliation
• Jennifer Powell Le

  • Family Nurse Practitioner
  • Katy, TX
  • NPI 1104661891

  Home health agency

  Care Compare affiliation
• Thomas R Lux, M.D.

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1003834409

  Home health agency

  Care Compare affiliation
• Margaret Kapor Manus, M.D.

  • Internal Medicine Physician
  • Bellaire, TX
  • NPI 1114334778

  Home health agency

  Care Compare affiliation
• Jennifer Meyer, MD

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1295712768

  Home health agency

  Care Compare affiliation
• Ashiya Momin, APRN

  • Family Nurse Practitioner
  • Katy, TX
  • NPI 1629826896

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617753600000",
    "number": "1063460483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 ROY RD STE 101",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775818601",
            "telephone_number": "281-997-6272",
            "fax_number": "281-997-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 ROY RD STE 101",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775818601",
            "telephone_number": "281-997-6272",
            "fax_number": "281-997-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDIAN HEALTH CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A",
        "authorized_official_last_name": "MOHAN",
        "authorized_official_first_name": "MERRILL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "281-997-6272"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "010276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICIENSED HOME HEALTH SRV",
            "identifier": "010276",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmohan@marathonhealth.com",
            "affiliation": "N",
            "endpointDescription": "address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2421 Roy Rd Ste 101",
            "city": "Pearland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775818601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmohan@marathonhealth.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2421 Roy Rd Ste 101",
            "city": "Pearland",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775818601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Home Health Agency in Pearland, TX
• Providers in Pearland, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.