Centerwell Senior Primary Care (TX) PA
Organization Active NPI Internal Medicine Physician · Houston, TX
NPI 1154903458 · NPPES record last updated Oct 18, 2022
Key facts
- NPI
- 1154903458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (TX) PA
- Practice address
- 388 W Little York Rd
Houston, TX 77076-1303 - Phone
- (346) 207-3170
- Fax
- (877) 872-7884
- NPI assigned
- Apr 26, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE (TX) PA
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 35
Corporate family (same tax ID) 29
Practitioners 4
-
Olga Lucila Garces-Vega, APRN-CNP, AGPCNP-C
-
Karina Gonzalez, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2230338 | Centerwell Senior Primary Care (TX) PA Dba | Certificate of waiver | Jul 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190327001232 | TX | Part B Supplier - Clinic/Group Practice | 4789950247 |
Receives reassigned benefits from 132 practitioners 35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Houston, TX; Humble, TX; McAllen, TX; Pantego, TX; Pasadena, TX; Port Arthur, TX; Richardson, TX; Richland Hills, TX… |
National Provider Directory
- Tax ID family
- Centerwell Senior Primary Care TX PA
- Part of
- Centerwell Senior Primary Care TX PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
388 W Little York Rd
Houston, TX 77076-1303
Mailing address
4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120
Other names
- CenterWell Senior Primary Care-Little York
Other providers in Houston, TX
- Centers for Mobility Rosenberg LP
- Centers for Pain Relief PLLC
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
- Centerwell Senior Primary Care (TX) PA
All providers in Houston, TX · Internal Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.