East Houston Medicine & Pediatrics Clinic PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

EAST HOUSTON MEDICINE & PEDIATRICS CLINIC PA

Practice address

12739 Woodforest Blvd Ste 2
Houston, TX 77015-2737

Phone

(713) 450-4455

Fax

(713) 450-4737

NPI assigned

Feb 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Cornelius Antoinne Wilson, MDNPI 1215032586

Title

Owner President

Phone

(713) 450-4455

Specialties & licenses 3

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

• Cornelius A Wilson, M.D.

  • Adolescent Medicine (Internal Medicine) Physician
  • Houston, TX
  • NPI 1215032586
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1083686091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24308",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772294308",
            "telephone_number": "713-450-4455",
            "fax_number": "713-450-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12739 WOODFOREST BLVD STE 2",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770152737",
            "telephone_number": "713-450-4455",
            "fax_number": "713-450-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST HOUSTON MEDICINE & PEDIATRICS CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_middle_name": "ANTOINNE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "713-450-4455",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "TX",
            "license": "J2845",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0081QD",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00L66J",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184593501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D1000292",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184593502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Houston Anesthesia PLLC
• East Houston Anesthesiology, P.a.
• East Houston Family Practice PA
• East Houston Kidney Center LP
• East Houston Medical Group
• East Houston Mint Dentistry, PLLC
• East Houston OBGYN & Associates
• East Houston Orthopedics & Sports Medicine, P.a.
• East Houston Pathology Group
• East Houston Physicians Group, PA

• Pediatrics Physician in Houston, TX
• Providers in Houston, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; 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.