Organization Active NPI

Houston Vein and Vascular PLLC

Doing business as Houston vein and vascular

  • Vascular & Interventional Radiology Physician
  • Bellaire, TX
National Provider Identifier
1114693504
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
HOUSTON VEIN AND VASCULAR PLLC
Doing business as
Houston vein and vascular
Practice address
6565 West Loop S Ste 110
Bellaire, TX 77401-3505
Phone
(713) 242-3000
NPI assigned
Aug 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Amelia Goodrum
Title
Administrative Assistant
Phone
(479) 242-2562

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

6565 West Loop S Ste 110
Bellaire, TX 77401-3505

Mailing address

5707 Jenny Lind Rd
Fort Smith, AR 72908-7435
Phone (479) 452-9416

Other practice location 1

837 Cypress Creek Pkwy Ste 106
Houston, TX 77090-3422
Phone (832) 350-7260

Other practice location 2

1211 Highway 6 Ste 70B
Sugar Land, TX 77478-4940
Phone (832) 350-7260

Other names 1

  • Houston vein and vascular Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211004003380 TX Part B Supplier - Clinic/Group Practice 6709284839 Receives reassigned benefits from 4 practitioners
Practice locations: Sugar Land, TX; Houston, TX; Bellaire, TX

National Provider Directory

National Provider Directory

Locations

604 N Main St
Gore, OK 74435
Phone (918) 489-5259

1211 Highway 6
Ste 70B
Sugar Land, TX 77478
Phone (832) 350-7260

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1114693504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5707 JENNY LIND RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729087435",
            "telephone_number": "479-452-9416",
            "fax_number": "479-242-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 WEST LOOP S STE 110",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774013505",
            "telephone_number": "713-242-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "837 Cypress Creek Pkwy Ste 106",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770903422",
            "country_code": "US",
            "telephone_number": "832-350-7260",
            "fax_number": "832-350-7261",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1211 Highway 6 Ste 70B",
            "address_purpose": "LOCATION",
            "city": "Sugar Land",
            "state": "TX",
            "postal_code": "774784940",
            "country_code": "US",
            "telephone_number": "832-350-7260",
            "fax_number": "832-350-7261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOUSTON VEIN AND VASCULAR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "GOODRUM",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "479-242-2562"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Houston vein and vascular",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellaire, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.