NPIMap

Organization Active NPI

Deerbrook Cath Lab LLC

Doing business as Vital Heart and Vein Cath Lab

  • Interventional Cardiology Physician
  • Humble, TX
National Provider Identifier
1104329440
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
DEERBROOK CATH LAB LLC
Doing business as
Vital Heart and Vein Cath Lab
Practice address
18450 Hwy 59 Suite 101
Humble, TX 77338
Phone
(281) 446-6656
Fax
(281) 446-6657
NPI assigned
Mar 13, 2018
Last updated
Jan 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Ricky Paul Ganim, MDNPI 1295843019
Title
Co-Owner
Phone
(281) 446-6656

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
Interventional Cardiology Physician 207RI0011X NU Primary

Addresses

Primary practice location

18450 Hwy 59 Suite 101
Humble, TX 77338

Mailing address

18450 Hwy 59 Suite 101
Humble, TX 77338
Phone (281) 446-6656

Other identifiers 2

IdentifierTypeStateIssuer
388654101MedicaidTX
663151OtherTXMEDICARE

Other names 1

  • Vital Heart and Vein Cath Lab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180604000395 TX Part B Supplier - Clinic/Group Practice 2466717996 Receives reassigned benefits from 30 practitioners
Practice locations: Humble, 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
45D2157428Deerbrook Cath Lab, LLC18450 Hwy 59, Ste 101-a, Humble, TX 77338AccreditationJun 16, 2028

National Provider Directory

National Provider Directory

Locations

18450 Highway 59 N
Humble, TX 77338
Phone (281) 446-3665

18450 Highway 59 N
Ste 101
Humble, TX 77338
Phone 5123086342506

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1104329440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18450 HWY 59 SUITE 101",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "77338",
            "telephone_number": "281-446-6656",
            "fax_number": "281-446-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18450 HWY 59 SUITE 101",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "77338",
            "telephone_number": "281-446-6656",
            "fax_number": "281-446-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEERBROOK CATH LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "GANIM",
        "authorized_official_first_name": "RICKY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "281-446-6656",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "388654101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "663151",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Heart and Vein Cath Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Humble, TX

Sources for this page

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